Provider Demographics
NPI:1972742666
Name:BOREL, SHARON M (LMSV)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:M
Last Name:BOREL
Suffix:
Gender:F
Credentials:LMSV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 DEMAREST AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994
Mailing Address - Country:US
Mailing Address - Phone:845-358-8809
Mailing Address - Fax:
Practice Address - Street 1:620 ROUTE #303
Practice Address - Street 2:
Practice Address - City:BLAUVELT
Practice Address - State:NY
Practice Address - Zip Code:10913
Practice Address - Country:US
Practice Address - Phone:845-353-2358
Practice Address - Fax:201-652-1613
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078193104100000X
NJ445L055363001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical