Provider Demographics
NPI:1932448040
Name:O'DONOGHUE-KNICKERBOCKER, SINEAD (LCSW)
Entity Type:Individual
Prefix:
First Name:SINEAD
Middle Name:
Last Name:O'DONOGHUE-KNICKERBOCKER
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 1:464 DECATUR ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-1501
Mailing Address - Country:US
Mailing Address - Phone:646-537-5705
Mailing Address - Fax:
Practice Address - Street 1:464 DECATUR ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-1501
Practice Address - Country:US
Practice Address - Phone:646-537-5705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0897001041C0700X
NY0885791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03505424Medicaid