MEDICARE: DR. SARA J. CORNELL PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PS016217	PA
2	103TC0700X	Clinical Psychologist	PY11370	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285851576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARA J. CORNELL PSY.D.

Provider Business Mailing Address
First Line	:	PO BOX 767
Second Line	:
City	:	POCONO LAKE
State	:	PA
Zip	:	18347-0767
Country	:	US
Telephone Number	:	570-991-2109
Fax Number	:

Provider Business Practice Location Address
First Line	:	906 ROUTE 940
Second Line	:
City	:	POCONO LAKE
State	:	PA
Zip	:	18347-7891
Country	:	US
Telephone Number	:	570-991-2109
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	06/04/2024

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