MEDICARE: M KIM SARASOHN PH.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	R045465-1	NY

General Provider Information

NPI Number	:	1538239157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	M KIM SARASOHN PH.D

Provider Business Mailing Address
First Line	:	352 7TH AVE
Second Line	:	SUITE 1604
City	:	NEW YORK
State	:	NY
Zip	:	10001-5012
Country	:	US
Telephone Number	:	212-873-2694
Fax Number	:

Provider Business Practice Location Address
First Line	:	352 7TH AVE
Second Line	:	SUITE 1604
City	:	NEW YORK
State	:	NY
Zip	:	10001-5012
Country	:	US
Telephone Number	:	212-873-2694
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	06/23/2014

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Directions to “ M KIM SARASOHN PH.D” Practice Location

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