Provider Demographics
NPI:1922450642
Name:WOLLABER, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:WOLLABER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 MINERAL SPRINGS RD APT 3
Mailing Address - Street 2:
Mailing Address - City:COBLESKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12043-5629
Mailing Address - Country:US
Mailing Address - Phone:518-590-6494
Mailing Address - Fax:
Practice Address - Street 1:113 PARK PL
Practice Address - Street 2:
Practice Address - City:SCHOHARIE
Practice Address - State:NY
Practice Address - Zip Code:12157-5211
Practice Address - Country:US
Practice Address - Phone:518-295-2031
Practice Address - Fax:518-295-8724
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02249145Medicaid