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General NPI Number Information
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NPI Number | 1669295382
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Entity Type | Individual
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Provider Name | SAHANA MOODABAGIL PSYD
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Gender | Female
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Dates
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Enumeration Date | 11/01/2024
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 215 E 50TH STREET
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City | NEW YORK
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State | NY
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Zip | 10022
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Country | US
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Telephone | 212-308-3118
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Fax |
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Provider Business Mailing Address
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Address Line | 110 NILES AVE
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City | LAKE FOREST
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State | IL
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Zip | 60045-2951
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Country | US
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Telephone | 847-226-7374
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 68-P132120-01
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License Number State | NY
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