Provider Demographics
NPI:1891915906
Name:SARRACCO, MICHELE (MSW LCSW)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:SARRACCO
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E 21ST STREET
Mailing Address - Street 2:SUITE #2E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-7417
Mailing Address - Country:US
Mailing Address - Phone:212-353-9264
Mailing Address - Fax:
Practice Address - Street 1:210 E 21ST STREET
Practice Address - Street 2:SUITE #2E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7417
Practice Address - Country:US
Practice Address - Phone:212-353-9264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR027046-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN79261Medicare ID - Type Unspecified