Provider Demographics
NPI:1164553780
Name:BUTTE, SARA (PHD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BUTTE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3552 LOWRY RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-1434
Mailing Address - Country:US
Mailing Address - Phone:323-913-0578
Mailing Address - Fax:323-887-1655
Practice Address - Street 1:3552 LOWRY RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-1434
Practice Address - Country:US
Practice Address - Phone:323-913-0578
Practice Address - Fax:323-887-1655
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19019103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 19019OtherPSYCHOLOGIST