Provider Demographics
NPI:1447385646
Name:STEVENS, SARAH JADE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:JADE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:872 S LUCERNE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-3708
Mailing Address - Country:US
Mailing Address - Phone:310-928-7810
Mailing Address - Fax:
Practice Address - Street 1:872 S LUCERNE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-3708
Practice Address - Country:US
Practice Address - Phone:310-928-7810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25737103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical