Provider Demographics
NPI:1447406053
Name:GARY, SHARON (MS, MHC)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:
Last Name:GARY
Suffix:
Gender:F
Credentials:MS, MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 BROADWAY STE 2060
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-3748
Mailing Address - Country:US
Mailing Address - Phone:646-586-3311
Mailing Address - Fax:
Practice Address - Street 1:225 BROADWAY STE 2060
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-3748
Practice Address - Country:US
Practice Address - Phone:646-586-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012162-1225100000X
NY18-P124562-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist