Provider Demographics
NPI:1366998197
Name:SWEETBAUM, SARA NICOLE (MS, MSED)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:NICOLE
Last Name:SWEETBAUM
Suffix:
Gender:F
Credentials:MS, MSED
Other - Prefix:MRS
Other - First Name:SARA
Other - Middle Name:NICOLE SWEETBAUM
Other - Last Name:TREIBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, MSED
Mailing Address - Street 1:750 TILDEN ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-6013
Mailing Address - Country:US
Mailing Address - Phone:718-231-3400
Mailing Address - Fax:
Practice Address - Street 1:201 E 66TH ST
Practice Address - Street 2:APARTMENT 8N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6451
Practice Address - Country:US
Practice Address - Phone:914-522-8639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool