Healthcare Provider Details

I. General information

NPI: 1609907237
Provider Name (Legal Business Name): KYOKO SAGARA LMHC, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 8TH ST APT 1
BROOKLYN NY
11215-7154
US

IV. Provider business mailing address

530 8TH ST
BROOKLYN NY
11215-4201
US

V. Phone/Fax

Practice location:
  • Phone: 347-217-3316
  • Fax:
Mailing address:
  • Phone: 347-217-3316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0003445-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number000620-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: