Provider Demographics
NPI:1780725507
Name:RANDALL, SARAH (PSYD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:RANDALL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23622 CALABASAS RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1549
Mailing Address - Country:US
Mailing Address - Phone:818-921-4300
Mailing Address - Fax:877-917-3450
Practice Address - Street 1:23622 CALABASAS RD
Practice Address - Street 2:SUITE 301
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1549
Practice Address - Country:US
Practice Address - Phone:818-921-4300
Practice Address - Fax:877-917-3450
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA26016103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program