Healthcare Provider Details

I. General information

NPI: 1205553450
Provider Name (Legal Business Name): SARAH SHAMIYA KHIARA HENDERSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E 1ST ST STE 201
CORNING NY
14830-2710
US

IV. Provider business mailing address

105 E 1ST ST STE 201
CORNING NY
14830-2710
US

V. Phone/Fax

Practice location:
  • Phone: 607-205-8848
  • Fax:
Mailing address:
  • Phone: 607-205-8848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number115165
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: