Provider Demographics
NPI:1174559785
Name:MOTCH, SALLIE M (PHD)
Entity type:Individual
Prefix:DR
First Name:SALLIE
Middle Name:M
Last Name:MOTCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 RIVERSIDE BLVD
Mailing Address - Street 2:#11-S
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10069-0701
Mailing Address - Country:US
Mailing Address - Phone:212-580-3067
Mailing Address - Fax:212-580-3068
Practice Address - Street 1:146 W 95TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6610
Practice Address - Country:US
Practice Address - Phone:212-866-0477
Practice Address - Fax:212-580-3068
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014815101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health