Provider Demographics
NPI:1669918777
Name:CUMMO, SARA
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:CUMMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27472 PORTOLA PKWY # 205-127
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-2853
Mailing Address - Country:US
Mailing Address - Phone:714-404-8877
Mailing Address - Fax:
Practice Address - Street 1:27472 PORTOLA PKWY # 205-127
Practice Address - Street 2:
Practice Address - City:FOOTHILL RANCH
Practice Address - State:CA
Practice Address - Zip Code:92610-2853
Practice Address - Country:US
Practice Address - Phone:714-404-8877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF88511101YM0800X
CA129703106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health