Provider Demographics
NPI:1174961544
Name:WICHMAN, SARAH (LMSW)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:
Last Name:WICHMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 BROADWAY
Mailing Address - Street 2:STE 200
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-3003
Mailing Address - Country:US
Mailing Address - Phone:917-685-7344
Mailing Address - Fax:
Practice Address - Street 1:39 BROADWAY
Practice Address - Street 2:STE 200
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-3003
Practice Address - Country:US
Practice Address - Phone:917-685-7344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72 0771831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical