Provider Demographics
NPI:1790980506
Name:DENNIS, SARA SORSBY
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:SORSBY
Last Name:DENNIS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:SORSBY
Other - Last Name:DENNIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:210 S GRAND AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-4205
Mailing Address - Country:US
Mailing Address - Phone:626-914-1980
Mailing Address - Fax:626-914-1984
Practice Address - Street 1:210 S GRAND AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4205
Practice Address - Country:US
Practice Address - Phone:626-914-1980
Practice Address - Fax:626-914-1984
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16301103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical