Healthcare Provider Details

I. General information

NPI: 1396561742
Provider Name (Legal Business Name): SARA SKODA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 RONALD AVE
HICKSVILLE NY
11801-2149
US

IV. Provider business mailing address

33 RONALD AVE
HICKSVILLE NY
11801-2149
US

V. Phone/Fax

Practice location:
  • Phone: 917-940-1005
  • Fax:
Mailing address:
  • Phone: 917-940-1005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number015372
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: