Provider Demographics
NPI:1891918595
Name:GOLDSMITH, SARA LYNN (MA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LYNN
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 TRENOR DR
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-3718
Mailing Address - Country:US
Mailing Address - Phone:914-632-2554
Mailing Address - Fax:
Practice Address - Street 1:1 GATEWAY PLZ
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-4674
Practice Address - Country:US
Practice Address - Phone:914-937-2320
Practice Address - Fax:914-937-3183
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool