Basic Information
| Provider Information | |||||||||
| NPI: | 1497990360 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WIDMAN | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 279 MAIN ST | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | NEW PALTZ | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125611623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452553046 | ||||||||
| FaxNumber: | 8452550236 | ||||||||
| Practice Location | |||||||||
| Address1: | 16 E 16TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100033105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129247744 | ||||||||
| FaxNumber: | 2126942786 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2008 | ||||||||
| LastUpdateDate: | 12/08/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 077992 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.