Provider Demographics
NPI:1750757704
Name:STUDENT, SARA (MS, CAS)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:STUDENT
Suffix:
Gender:F
Credentials:MS, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WARSAW AVE
Mailing Address - Street 2:20
Mailing Address - City:MECHANICVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12118-1135
Mailing Address - Country:US
Mailing Address - Phone:518-424-2169
Mailing Address - Fax:
Practice Address - Street 1:25 WARSAW AVE
Practice Address - Street 2:20
Practice Address - City:MECHANICVILLE
Practice Address - State:NY
Practice Address - Zip Code:12118-1135
Practice Address - Country:US
Practice Address - Phone:518-424-2169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool