Provider Demographics
NPI:1083746044
Name:SACKS, DAVID A (MA, LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:SACKS
Suffix:
Gender:M
Credentials:MA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9730 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2022
Mailing Address - Country:US
Mailing Address - Phone:310-247-1604
Mailing Address - Fax:310-278-8468
Practice Address - Street 1:9730 WILSHIRE BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2022
Practice Address - Country:US
Practice Address - Phone:310-247-1604
Practice Address - Fax:310-278-8468
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS#215371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical