Provider Demographics
NPI:1790938512
Name:SACKLES, JOANMARIE A (DOCTORATE)
Entity Type:Individual
Prefix:DR
First Name:JOANMARIE
Middle Name:A
Last Name:SACKLES
Suffix:
Gender:F
Credentials:DOCTORATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 694
Mailing Address - Street 2:
Mailing Address - City:AMAWALK
Mailing Address - State:NY
Mailing Address - Zip Code:10501-0694
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31 BEDELL RD
Practice Address - Street 2:
Practice Address - City:AMAWALK
Practice Address - State:NY
Practice Address - Zip Code:10501-1500
Practice Address - Country:US
Practice Address - Phone:914-245-5535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007417103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist