Healthcare Provider Details

I. General information

NPI: 1861793499
Provider Name (Legal Business Name): SARAH POLE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 11/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2590 FRISBY AVE
BRONX NY
10461-3240
US

IV. Provider business mailing address

PO BOX 26911
NEW YORK NY
10087-6911
US

V. Phone/Fax

Practice location:
  • Phone: 718-239-1610
  • Fax: 718-792-7053
Mailing address:
  • Phone: 800-444-6020
  • Fax: 845-256-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number082615
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: