Basic Information
| Provider Information | |||||||||
| NPI: | 1962097485 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HASBUN | ||||||||
| FirstName: | SOURELLY | ||||||||
| MiddleName: | C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 316 NORTH BROADWAY | ||||||||
| Address2: | |||||||||
| City: | SLEEPY HOLLOW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146314141 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 316 NORTH BROADWAY | ||||||||
| Address2: | |||||||||
| City: | SLEEPY HOLLOW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146314141 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2021 | ||||||||
| LastUpdateDate: | 03/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YS0200X | 1231964181 | NY | N | Behavioral Health & Social Service Providers | Counselor | School | 101YM0800X | 103646-01 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.