Provider Demographics
NPI:1790926111
Name:MOMPOINT, SANDY
Entity Type:Individual
Prefix:MS
First Name:SANDY
Middle Name:
Last Name:MOMPOINT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18714 RIDGEDALE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-1417
Mailing Address - Country:US
Mailing Address - Phone:718-736-3554
Mailing Address - Fax:718-502-5334
Practice Address - Street 1:18714 RIDGEDALE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-1417
Practice Address - Country:US
Practice Address - Phone:718-736-3554
Practice Address - Fax:718-502-5334
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-14
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X
172V00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No172V00000XOther Service ProvidersCommunity Health Worker