Provider Demographics
NPI:1568880870
Name:LEVENE, SARAH TANIYAMA
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:TANIYAMA
Last Name:LEVENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:TANIYAMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:541 W. CAPITOL EXPY
Mailing Address - Street 2:SUITE 10 PMB 125
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136
Mailing Address - Country:US
Mailing Address - Phone:858-442-4549
Mailing Address - Fax:
Practice Address - Street 1:950 S BASCOM AVE STE 103
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3536
Practice Address - Country:US
Practice Address - Phone:858-442-4549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120719106H00000X
CA94529101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist