Provider Demographics
NPI:1396898953
Name:CANTRELL, SARAH ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:ANN
Last Name:CANTRELL
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 1:747 52ND ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1809
Mailing Address - Country:US
Mailing Address - Phone:510-428-8401
Mailing Address - Fax:510-238-9764
Practice Address - Street 1:312 CLAY ST STE 150
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-3510
Practice Address - Country:US
Practice Address - Phone:510-428-8401
Practice Address - Fax:510-238-9764
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD1000072101Y00000X
CA25649103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor