Provider Demographics
NPI:1073267175
Name:SAUER CLARK, BRANDY A
Entity type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:A
Last Name:SAUER CLARK
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 1:14 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12913-7715
Mailing Address - Country:US
Mailing Address - Phone:518-312-0066
Mailing Address - Fax:
Practice Address - Street 1:14 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:12913-7715
Practice Address - Country:US
Practice Address - Phone:518-312-0066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
12345OtherST JOSEPHS REHABILITATION CENTER, INC