Provider Demographics
NPI:1952773707
Name:BROTHWELL, SARAH MANNING (MS)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MANNING
Last Name:BROTHWELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 WEST AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-1047
Mailing Address - Country:US
Mailing Address - Phone:716-200-7767
Mailing Address - Fax:
Practice Address - Street 1:552 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-2915
Practice Address - Country:US
Practice Address - Phone:716-200-7767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YS0200X
NY008670101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool