=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346728821
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SONDRA ANN AUSTIN LCSW-R
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2018
-----------------------------------------------------
Last Update Date | 08/06/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 HICKSVILLE RD STE 5
-----------------------------------------------------
City | MASSAPEQUA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11758-5819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-967-5221
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19 SCHENCK AVE APT 3C
-----------------------------------------------------
City | GREAT NECK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11021-3613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-967-5221
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | R045248-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------