Provider Demographics
NPI:1790764793
Name:SAKHAROVA, ANNA (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:SAKHAROVA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5955 47TH AVE
Mailing Address - Street 2:APT.6B
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-5662
Mailing Address - Country:US
Mailing Address - Phone:718-672-1537
Mailing Address - Fax:718-672-1537
Practice Address - Street 1:5955 47TH AVE
Practice Address - Street 2:APT.6B
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-5662
Practice Address - Country:US
Practice Address - Phone:718-672-1537
Practice Address - Fax:718-672-1537
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0511231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01742745Medicaid
NYN6R781Medicare PIN
NY01742745Medicaid
NY05260Medicare PIN