Provider Demographics
NPI:1457799322
Name:THOMPSON, SARAH MADELINE (PHD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MADELINE
Last Name:THOMPSON
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 1:720 WILSHIRE BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1737
Mailing Address - Country:US
Mailing Address - Phone:626-344-2419
Mailing Address - Fax:
Practice Address - Street 1:720 WILSHIRE BLVD STE 204
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1737
Practice Address - Country:US
Practice Address - Phone:626-344-2419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34690103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical