Provider Demographics
NPI:1558886838
Name:HANEY, SARAH CARBONEL
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:CARBONEL
Last Name:HANEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 RESERVATION RD # F238
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-3179
Mailing Address - Country:US
Mailing Address - Phone:669-278-4236
Mailing Address - Fax:
Practice Address - Street 1:266 RESERVATION RD # F238
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-3179
Practice Address - Country:US
Practice Address - Phone:669-278-4236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-08
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101067106H00000X
CA129427106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist