Provider Demographics
NPI:1023261229
Name:LIBONATI, SARA BURRIS (MS,ED)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:BURRIS
Last Name:LIBONATI
Suffix:
Gender:F
Credentials:MS,ED
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:ELIZABETH
Other - Last Name:BURRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,ED
Mailing Address - Street 1:35 HIGHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-2007
Mailing Address - Country:US
Mailing Address - Phone:203-244-5355
Mailing Address - Fax:
Practice Address - Street 1:95 BRADHURST AVE
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1637
Practice Address - Country:US
Practice Address - Phone:914-592-7138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X, 222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist