Provider Demographics
NPI:1073289849
Name:FROMBOLUTI, SARA (PSTD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:FROMBOLUTI
Suffix:
Gender:F
Credentials:PSTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:WAIMEA
Mailing Address - State:HI
Mailing Address - Zip Code:96796-0518
Mailing Address - Country:US
Mailing Address - Phone:808-651-5427
Mailing Address - Fax:
Practice Address - Street 1:9555 HUAKAI RD
Practice Address - Street 2:
Practice Address - City:WAIMEA
Practice Address - State:HI
Practice Address - Zip Code:96796
Practice Address - Country:US
Practice Address - Phone:808-651-5427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY946657103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool