Provider Demographics
NPI:1083275507
Name:SUTERA, SARA ALLISON
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ALLISON
Last Name:SUTERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ALLISON
Other - Last Name:TOWNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:510 E MAGNOLIA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-1850
Mailing Address - Country:US
Mailing Address - Phone:209-938-0831
Mailing Address - Fax:209-938-0849
Practice Address - Street 1:510 E MAGNOLIA ST STE 100
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1850
Practice Address - Country:US
Practice Address - Phone:209-938-0831
Practice Address - Fax:209-938-0849
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA113435106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist