Provider Demographics
NPI:1376710871
Name:SACKETT AFFILIATES
Entity Type:Organization
Organization Name:SACKETT AFFILIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:408-257-6662
Mailing Address - Street 1:1745 SARATOGA AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-5201
Mailing Address - Country:US
Mailing Address - Phone:408-257-6662
Mailing Address - Fax:
Practice Address - Street 1:1745 SARATOGA AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-5201
Practice Address - Country:US
Practice Address - Phone:408-257-6662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18785103T00000X
CA33627106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty