Provider Demographics
NPI:1891867305
Name:MANDELBAUM, SARA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:MANDELBAUM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:MANDELBAUM
Other - Last Name:STUKALIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:101 WEST 12TH STREET
Mailing Address - Street 2:SUITE 6K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8112
Mailing Address - Country:US
Mailing Address - Phone:718-544-9198
Mailing Address - Fax:718-544-6400
Practice Address - Street 1:101 WEST 12TH STREET
Practice Address - Street 2:SUITE 6K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8112
Practice Address - Country:US
Practice Address - Phone:718-544-9198
Practice Address - Fax:718-544-6400
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006690103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist