Provider Demographics
NPI:1588054753
Name:SACCA, JAMIE M (LCAT MT-BC)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:M
Last Name:SACCA
Suffix:
Gender:F
Credentials:LCAT MT-BC
Other - Prefix:MRS
Other - First Name:JAMIE
Other - Middle Name:M
Other - Last Name:DOSTAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2361 CRESCENT ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11105-3107
Mailing Address - Country:US
Mailing Address - Phone:631-525-6930
Mailing Address - Fax:
Practice Address - Street 1:2361 CRESCENT ST
Practice Address - Street 2:2ND FL
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11105-3107
Practice Address - Country:US
Practice Address - Phone:631-525-6930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY09582225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist