Healthcare Provider Details

I. General information

NPI: 1194644096
Provider Name (Legal Business Name): SABLE DOMINIQUE PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

864 HEWITT PL APT 5C
BRONX NY
10459-4065
US

IV. Provider business mailing address

864 HEWITT PL APT 5C
BRONX NY
10459-4065
US

V. Phone/Fax

Practice location:
  • Phone: 347-852-2110
  • Fax:
Mailing address:
  • Phone: 347-632-4532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number130928-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: