Provider Demographics
NPI:1457503153
Name:LAWRENCE, SALLY (MFT)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1588 HOMESTEAD RD # MB10
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-4783
Mailing Address - Country:US
Mailing Address - Phone:408-774-1009
Mailing Address - Fax:408-249-2291
Practice Address - Street 1:1588 HOMESTEAD RD # MB10
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-4783
Practice Address - Country:US
Practice Address - Phone:408-774-1009
Practice Address - Fax:408-249-2291
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT38458106H00000X
CAMFC 38458171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator