Provider Demographics
NPI:1396994299
Name:SHARP, MYRNA SUE (LP)
Entity type:Individual
Prefix:
First Name:MYRNA
Middle Name:SUE
Last Name:SHARP
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 21ST ST
Mailing Address - Street 2:APT 3R
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-7406
Mailing Address - Country:US
Mailing Address - Phone:212-473-3928
Mailing Address - Fax:
Practice Address - Street 1:200 E 21ST ST
Practice Address - Street 2:APT 3R
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7406
Practice Address - Country:US
Practice Address - Phone:212-473-3928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000500-1101Y00000X, 102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst