Provider Demographics
NPI:1871678599
Name:CHAPLAIN, SANDRA ANN (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:SANDRA
Middle Name:ANN
Last Name:CHAPLAIN
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 1:26 COURT STREET
Mailing Address - Street 2:SUITE 2604
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11242-1126
Mailing Address - Country:US
Mailing Address - Phone:718-488-7977
Mailing Address - Fax:
Practice Address - Street 1:26 COURT STREET
Practice Address - Street 2:SUITE 2604
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-1126
Practice Address - Country:US
Practice Address - Phone:718-488-7977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0277651101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN48001Medicare ID - Type Unspecified