Provider Demographics
NPI:1780007690
Name:ROSE, SARAH (LMFT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 NAGLEE RD STE 138
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95304-7324
Mailing Address - Country:US
Mailing Address - Phone:209-346-7411
Mailing Address - Fax:209-740-4494
Practice Address - Street 1:2455 NAGLEE RD STE 138
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95304-7324
Practice Address - Country:US
Practice Address - Phone:209-346-7411
Practice Address - Fax:209-740-4494
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105322106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist