Provider Demographics
NPI:1558426247
Name:VIOLA, SARA (LCSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:VIOLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56925 YUCCA TRL # 564
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-7913
Mailing Address - Country:US
Mailing Address - Phone:760-365-0788
Mailing Address - Fax:760-418-8435
Practice Address - Street 1:57475 29 PALMS HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2906
Practice Address - Country:US
Practice Address - Phone:760-365-0788
Practice Address - Fax:760-418-8435
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-24
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS102761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ12954ZOtherOTHER-MEDICARE PTAN
CA06J5394Medicaid