Provider Demographics
NPI:1861023020
Name:SAWYER, WIDYASITA (PHD)
Entity Type:Individual
Prefix:
First Name:WIDYASITA
Middle Name:
Last Name:SAWYER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1189 CURTNER AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-3618
Mailing Address - Country:US
Mailing Address - Phone:408-887-9642
Mailing Address - Fax:
Practice Address - Street 1:1189 CURTNER AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-3618
Practice Address - Country:US
Practice Address - Phone:408-887-9642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31564103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical