Provider Demographics
NPI:1598510885
Name:AXUME, SARAH (PSYD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:AXUME
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:PO BOX 39A71
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-0071
Mailing Address - Country:US
Mailing Address - Phone:818-317-0231
Mailing Address - Fax:
Practice Address - Street 1:2898 ROWENA AVE STE 206
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-2096
Practice Address - Country:US
Practice Address - Phone:213-873-6133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY34999103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist