Provider Demographics
NPI:1417062597
Name:SAKAHARA, KARIN KIYOKO (LCSW)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:KIYOKO
Last Name:SAKAHARA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KARIN
Other - Middle Name:KIYOKO
Other - Last Name:KASHIMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1151 DOVE ST
Mailing Address - Street 2:SUITE 295
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2840
Mailing Address - Country:US
Mailing Address - Phone:949-955-9263
Mailing Address - Fax:949-955-9259
Practice Address - Street 1:1151 DOVE ST
Practice Address - Street 2:SUITE 295
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2840
Practice Address - Country:US
Practice Address - Phone:949-955-9263
Practice Address - Fax:949-955-9259
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS202161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical