Healthcare Provider Details

I. General information

NPI: 1831766427
Provider Name (Legal Business Name): MICHELLE ROSE SARDONE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 BLOOMINGDALE RD
WHITE PLAINS NY
10605-1504
US

IV. Provider business mailing address

21 BLOOMINGDALE RD
WHITE PLAINS NY
10605-1504
US

V. Phone/Fax

Practice location:
  • Phone: 914-997-5748
  • Fax: 914-997-8635
Mailing address:
  • Phone: 914-997-5748
  • Fax: 914-997-8635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number073800
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: