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General NPI Number Information
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NPI Number | 1437428885
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Entity Type | Individual
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Provider Name | ELLANA SANDERS MT- BC LCAT, CCBT
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Gender | Female
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Dates
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Enumeration Date | 12/14/2011
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Last Update Date | 11/28/2016
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Provider Practice Location Address
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Address Line | 3850 BELL BLVD SUITE A
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City | BAYSIDE
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State | NY
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Zip | 11361-2168
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Country | US
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Telephone | 917-520-7476
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Fax |
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Provider Business Mailing Address
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Address Line | 3850 BELL BLVD SUITE A
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City | BAYSIDE
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State | NY
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Zip | 11361-2168
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Country | US
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Telephone | 917-520-7476
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 000817-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225A00000X
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Taxonomy Name | Music Therapist
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License Number | BC
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License Number State | NY
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