Provider Demographics
NPI:1801926472
Name:HALLIDAY, SARAH TUCKER (MSW)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:TUCKER
Last Name:HALLIDAY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GLEN LANE
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-1120
Mailing Address - Country:US
Mailing Address - Phone:516-759-4658
Mailing Address - Fax:516-759-4521
Practice Address - Street 1:6 GLEN LANE
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-1120
Practice Address - Country:US
Practice Address - Phone:516-759-4658
Practice Address - Fax:516-759-4521
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO 193581104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
39312Medicare ID - Type Unspecified