Provider Demographics
NPI:1922549914
Name:BIRDSONG, SARAH LARKIN (LMHC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LARKIN
Last Name:BIRDSONG
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 ENGERT AVE
Mailing Address - Street 2:APT 1R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-5247
Mailing Address - Country:US
Mailing Address - Phone:909-455-4549
Mailing Address - Fax:
Practice Address - Street 1:331 LEONARD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-2309
Practice Address - Country:US
Practice Address - Phone:513-818-2473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007283101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health