Healthcare Provider Details

I. General information

NPI: 1912309741
Provider Name (Legal Business Name): SARAH ELIZABETH NOLAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PINE WEST PLZ SUITE 511
ALBANY NY
12205-5587
US

IV. Provider business mailing address

445 STATE ST APT 2
ALBANY NY
12203-1055
US

V. Phone/Fax

Practice location:
  • Phone: 973-715-0542
  • Fax:
Mailing address:
  • Phone: 973-715-0542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number020717
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: