Healthcare Provider Details

I. General information

NPI: 1013144054
Provider Name (Legal Business Name): SHARON BREBAN LMSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 HARBOR DR
CEDARHURST NY
11516-1014
US

IV. Provider business mailing address

534 HARBOR DR
CEDARHURST NY
11516-1014
US

V. Phone/Fax

Practice location:
  • Phone: 516-295-7959
  • Fax:
Mailing address:
  • Phone: 516-316-7965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number083339
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6704119
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: