Provider Demographics
NPI:1619157864
Name:WOLFARTH-DAVIS, SARAH ELLEN (PHD, LMFT)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:ELLEN
Last Name:WOLFARTH-DAVIS
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:ELLEN
Other - Last Name:WOLFARTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:530 43RD ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2036
Mailing Address - Country:US
Mailing Address - Phone:951-310-9709
Mailing Address - Fax:
Practice Address - Street 1:2940 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3416
Practice Address - Country:US
Practice Address - Phone:951-310-9709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA110345106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator