Healthcare Provider Details

I. General information

NPI: 1477632297
Provider Name (Legal Business Name): SARRAH BRONSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 10/15/2023
Certification Date: 10/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 FAIR ST STE 17B
KINGSTON NY
12401-3882
US

IV. Provider business mailing address

4D HOLLAND DR
WEST HURLEY NY
12491-5615
US

V. Phone/Fax

Practice location:
  • Phone: 914-391-7078
  • Fax:
Mailing address:
  • Phone: 914-391-7078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number8140
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8140
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number8140
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: