Provider Demographics
NPI:1184492118
Name:MORAN, SARA JOSEFINA (PPSC, AMFT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JOSEFINA
Last Name:MORAN
Suffix:
Gender:F
Credentials:PPSC, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 LINCOLN AVE STE 150-8493
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-3043
Mailing Address - Country:US
Mailing Address - Phone:408-420-9526
Mailing Address - Fax:
Practice Address - Street 1:1865 MONROVIA DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1505
Practice Address - Country:US
Practice Address - Phone:408-270-4992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YS0200X
CA141712106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool