Provider Demographics
NPI:1841575842
Name:AMPUDIA, SARA ESTHER (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:ESTHER
Last Name:AMPUDIA
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1178 BROADWAY FL 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5666
Mailing Address - Country:US
Mailing Address - Phone:860-966-9192
Mailing Address - Fax:
Practice Address - Street 1:1178 BROADWAY, 3RD FLOOR
Practice Address - Street 2:#1279
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:860-966-9192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084994-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker