Provider Demographics
NPI:1629309497
Name:STUART, SORRENTA CHANTEL (MFT)
Entity Type:Individual
Prefix:MS
First Name:SORRENTA
Middle Name:CHANTEL
Last Name:STUART
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 PINE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-3633
Mailing Address - Country:US
Mailing Address - Phone:925-963-5353
Mailing Address - Fax:925-945-3419
Practice Address - Street 1:1250 PINE ST STE 100
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3633
Practice Address - Country:US
Practice Address - Phone:925-963-5353
Practice Address - Fax:925-945-3419
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47901106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist