Provider Demographics
NPI:1023312006
Name:WILSON, SARAH MALLARD (PSYD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MALLARD
Last Name:WILSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 WHITE PLAINS RD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5198
Mailing Address - Country:US
Mailing Address - Phone:914-345-5900
Mailing Address - Fax:914-592-3829
Practice Address - Street 1:20 S BROADWAY
Practice Address - Street 2:SUITE 1109
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-3713
Practice Address - Country:US
Practice Address - Phone:914-345-0700
Practice Address - Fax:914-207-6590
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP78680103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical