Provider Demographics
NPI:1447932645
Name:PRIBANICH, SARA ANN
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:PRIBANICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14487-9703
Mailing Address - Country:US
Mailing Address - Phone:585-346-4000
Mailing Address - Fax:
Practice Address - Street 1:40 SPRING ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:NY
Practice Address - Zip Code:14487-9703
Practice Address - Country:US
Practice Address - Phone:585-346-4000
Practice Address - Fax:585-346-9605
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115257-011041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool