Provider Demographics
NPI:1851686463
Name:KASUGA-JENKS, SARAH NAOMI (PHD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:NAOMI
Last Name:KASUGA-JENKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:NAOMI
Other - Last Name:KASUGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2407 DANA ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2207
Mailing Address - Country:US
Mailing Address - Phone:510-548-5858
Mailing Address - Fax:
Practice Address - Street 1:2407 DANA ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2207
Practice Address - Country:US
Practice Address - Phone:510-548-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAPSY25914103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program