=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720603863
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARA LAVNER M.A.,NCPSYA,L.P.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2020
-----------------------------------------------------
Last Update Date | 06/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 80 FITH AVENUE SUITE 1503
-----------------------------------------------------
City | NEW YORK CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-613-5237
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 315 EASR 68TH STREET APT. 13 S
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-613-5237
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 102L00000X
-----------------------------------------------------
Taxonomy Name | Psychoanalyst
-----------------------------------------------------
License Number | 000178
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------