Healthcare Provider Details

I. General information

NPI: 1245912849
Provider Name (Legal Business Name): SARA BABAD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7559 263RD ST
GLEN OAKS NY
11004-1100
US

IV. Provider business mailing address

350 PACIFIC AVE
CEDARHURST NY
11516-1814
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-3561
  • Fax:
Mailing address:
  • Phone: 516-578-5698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number68-P118180-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number68-P118180-01
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number68-P118180-01
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number68-P118180-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: