Provider Demographics
NPI:1669909073
Name:EGA, SASHA CAROLINA (LCSW)
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:CAROLINA
Last Name:EGA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9131 QUEENS BLVD STE 601
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5543
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 W 39TH ST RM 705
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-3874
Practice Address - Country:US
Practice Address - Phone:315-816-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2024-05-20
Deactivation Date:2018-06-15
Deactivation Code:
Reactivation Date:2018-07-31
Provider Licenses
StateLicense IDTaxonomies
NY18003951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical