Provider Demographics
NPI:1194784736
Name:LUGO, SANDRA (LCSW)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:LUGO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 6TH AVE
Mailing Address - Street 2:APARTMENT 2A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3350
Mailing Address - Country:US
Mailing Address - Phone:718-499-5844
Mailing Address - Fax:
Practice Address - Street 1:412 6TH AVE
Practice Address - Street 2:SUITE 403-404
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8409
Practice Address - Country:US
Practice Address - Phone:718-809-7244
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP065490-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN6Z251Medicare ID - Type UnspecifiedMENTAL HEALTH MEDICARE