Provider Demographics
NPI:1255822730
Name:SANBORN, SALLIE ANNE (MS)
Entity type:Individual
Prefix:MS
First Name:SALLIE
Middle Name:ANNE
Last Name:SANBORN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 WEST 95TH STREET SUITE 1E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:917-748-8356
Mailing Address - Fax:
Practice Address - Street 1:146 WEST 95TH STREET SUITE 1E
Practice Address - Street 2:SUITE 1E
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10025
Practice Address - Country:US
Practice Address - Phone:917-748-8356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health