Provider Demographics
NPI:1437417003
Name:MADRIGAL, SARA ANN (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:MADRIGAL
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 1ST ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1177
Mailing Address - Country:US
Mailing Address - Phone:707-980-2262
Mailing Address - Fax:925-756-2055
Practice Address - Street 1:819 1ST ST STE B
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-1106
Practice Address - Country:US
Practice Address - Phone:707-980-2262
Practice Address - Fax:925-281-2856
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2018-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC51385106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist