Provider Demographics
NPI:1952454860
Name:SKLAR, SANDRA SMITH (MSW)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:SMITH
Last Name:SKLAR
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-0424
Mailing Address - Country:US
Mailing Address - Phone:845-876-1176
Mailing Address - Fax:
Practice Address - Street 1:58 E MARKET ST
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1606
Practice Address - Country:US
Practice Address - Phone:845-876-1176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO45317-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY799091OtherMVP
NY799091OtherMVP