Provider Demographics
NPI:1134497027
Name:GIFFORD, SARA CAMILLE (MFT)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:CAMILLE
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 COLLEGE STREET #762
Mailing Address - Street 2:
Mailing Address - City:ETNA
Mailing Address - State:CA
Mailing Address - Zip Code:96027-0762
Mailing Address - Country:US
Mailing Address - Phone:650-814-4686
Mailing Address - Fax:
Practice Address - Street 1:3790 EL CAMINO REAL # 102
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-3314
Practice Address - Country:US
Practice Address - Phone:650-283-5778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC48594106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist