Provider Demographics
NPI:1861521155
Name:BORDEN, SANDRA L (LCSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:BORDEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 WEST END AVENUE
Mailing Address - Street 2:#1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7361
Mailing Address - Country:US
Mailing Address - Phone:212-316-7057
Mailing Address - Fax:
Practice Address - Street 1:677 WEST END AVENUE
Practice Address - Street 2:#1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7361
Practice Address - Country:US
Practice Address - Phone:212-316-7057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR034687-1103TP0814X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
476308OtherVALUE OPTIONS
174392OtherELDERPLAN
174392OtherELDERPLAN