Provider Demographics
NPI:1841261450
Name:PARRA, SANDRA JOAN (MSW LCSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JOAN
Last Name:PARRA
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:JOAN
Other - Last Name:SALKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW CSW
Mailing Address - Street 1:35 MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10977
Mailing Address - Country:US
Mailing Address - Phone:845-348-7798
Mailing Address - Fax:
Practice Address - Street 1:37 SOUTH BROADWAY
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960
Practice Address - Country:US
Practice Address - Phone:845-348-7798
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03446611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN2J461Medicare ID - Type Unspecified