Provider Demographics
NPI:1285788109
Name:GEORGE, SALLY (PHD)
Entity type:Individual
Prefix:DR
First Name:SALLY
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:NY
Mailing Address - Zip Code:13753-1213
Mailing Address - Country:US
Mailing Address - Phone:607-746-8899
Mailing Address - Fax:607-746-8899
Practice Address - Street 1:140 MAIN ST
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:NY
Practice Address - Zip Code:13753-1213
Practice Address - Country:US
Practice Address - Phone:607-746-8899
Practice Address - Fax:607-746-8899
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012373-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVS0211Medicare ID - Type UnspecifiedMEDICARE NUMBER