Healthcare Provider Details

I. General information

NPI: 1184309403
Provider Name (Legal Business Name): SARAH ELIZABETH MOYER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 GRAND BLVD STE 17
DEER PARK NY
11729-5725
US

IV. Provider business mailing address

770 GRAND BLVD STE 17
DEER PARK NY
11729-5725
US

V. Phone/Fax

Practice location:
  • Phone: 585-362-1939
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number114919
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: