Provider Demographics
NPI:1295877850
Name:BERNSTEIN, SARA L (MSW LCSW ACSW)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:L
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:MSW LCSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 HALLOCK RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3033
Mailing Address - Country:US
Mailing Address - Phone:631-689-0418
Mailing Address - Fax:
Practice Address - Street 1:207 HALLOCK RD
Practice Address - Street 2:SUITE 204
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3033
Practice Address - Country:US
Practice Address - Phone:631-689-0418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036252104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY800009180OtherRRMC
NY800009180OtherRRMC