Provider Demographics
NPI:1851508451
Name:LORD, SALLY S (SALLY LORD CSW)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:S
Last Name:LORD
Suffix:
Gender:F
Credentials:SALLY LORD CSW
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:LORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:350 CENTRAL PARK W
Mailing Address - Street 2:6B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6547
Mailing Address - Country:US
Mailing Address - Phone:212-865-1243
Mailing Address - Fax:
Practice Address - Street 1:350 CENTRAL PARK W
Practice Address - Street 2:6B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6547
Practice Address - Country:US
Practice Address - Phone:212-865-1243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO182491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN38041OtherPIN