Healthcare Provider Details

I. General information

NPI: 1588821110
Provider Name (Legal Business Name): ANN MARIE SACRAMONE MSED LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41-51 EAST 11TH ST 4TH FLOOR
NEW YORK NY
10003
US

IV. Provider business mailing address

38 CLUBHOUSE RD
PUTNAM VALLEY NY
10579-1509
US

V. Phone/Fax

Practice location:
  • Phone: 917-515-3688
  • Fax:
Mailing address:
  • Phone: 917-514-3688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number000504
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: