Provider Demographics
NPI:1841543386
Name:EPOSITO SAN ROMAN, SASHA CREMELLE (MFT)
Entity type:Individual
Prefix:MS
First Name:SASHA
Middle Name:CREMELLE
Last Name:EPOSITO SAN ROMAN
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:PO BOX 111611
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95011-1611
Mailing Address - Country:US
Mailing Address - Phone:408-378-6510
Mailing Address - Fax:
Practice Address - Street 1:2170 THE ALAMEDA
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1131
Practice Address - Country:US
Practice Address - Phone:408-378-6510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 37388106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist