Provider Demographics
NPI:1013144054
Name:BREBAN, SHARON (LMSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:BREBAN
Suffix:
Gender:F
Credentials:LMSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-1014
Mailing Address - Country:US
Mailing Address - Phone:516-316-7965
Mailing Address - Fax:
Practice Address - Street 1:534 HARBOR DR
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-1014
Practice Address - Country:US
Practice Address - Phone:516-295-7959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0833391041C0700X
NY6704119104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker