Provider Demographics
NPI:1265571970
Name:BRANDT-DOUGLAS, SARAH (LCSW-R)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:BRANDT-DOUGLAS
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:BRANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:538 BEWLEY BUILDING
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-2944
Mailing Address - Country:US
Mailing Address - Phone:716-417-5934
Mailing Address - Fax:716-727-0073
Practice Address - Street 1:538 BEWLEY BUILDING
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-2944
Practice Address - Country:US
Practice Address - Phone:716-417-5934
Practice Address - Fax:716-727-0073
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0297641104100000X
1041C0700X
NYR029764-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0051614690900OtherCIGNA
NY0404260300851OtherFIDELIS
NY7404799OtherVALUE OPTION
NY6207257OtherIHA
NY000510025003OtherBCBS
NY00020562201OtherUNIVERA
NY6622OtherPIN
NY01594678Medicaid
NY00020562201OtherUNIVERA
NY6207257OtherIHA