Provider Demographics
NPI:1043904402
Name:GRANOVETTER, SARA (LMFT, PHD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:GRANOVETTER
Suffix:
Gender:F
Credentials:LMFT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:879 MAYFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-1052
Mailing Address - Country:US
Mailing Address - Phone:415-992-1470
Mailing Address - Fax:
Practice Address - Street 1:93 WOOD LN
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:CA
Practice Address - Zip Code:94930-2015
Practice Address - Country:US
Practice Address - Phone:415-992-1470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA116255101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor