Basic Information
Provider Information | |||||||||
NPI: | 1720223241 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TEICHBERG-SABATH | ||||||||
FirstName: | ETHEL | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PSYD, LCSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 90 HIGHLAND LN | ||||||||
Address2: |   | ||||||||
City: | IRVINGTON | ||||||||
State: | NY | ||||||||
PostalCode: | 105331845 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9148938442 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1745 BROADWAY FL 17 | ||||||||
Address2: |   | ||||||||
City: | NEW YORK | ||||||||
State: | NY | ||||||||
PostalCode: | 100194642 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2128518102 | ||||||||
FaxNumber: | 2125370102 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/12/2008 | ||||||||
LastUpdateDate: | 03/17/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 00073294 | NY | N |   | Behavioral Health & Social Service Providers | Social Worker | Clinical | 103TC0700X | 021445 | NY | Y |   | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.