Healthcare Provider Details

I. General information

NPI: 1669623344
Provider Name (Legal Business Name): SAHAR KHOSHAKHLAGH PSYD, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 W 23RD ST STE 500
NEW YORK NY
10011-2599
US

IV. Provider business mailing address

116 W 23RD ST STE 500
NEW YORK NY
10011-2599
US

V. Phone/Fax

Practice location:
  • Phone: 212-203-2758
  • Fax:
Mailing address:
  • Phone: 212-203-2758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number133306195
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000775-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: