Provider Demographics
NPI:1982485835
Name:ELLIOTT, SARAH D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:D
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:D
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DR SARAH ELLIOTT
Mailing Address - Street 1:5150 FAIR OAKS BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-5758
Mailing Address - Country:US
Mailing Address - Phone:916-899-1750
Mailing Address - Fax:
Practice Address - Street 1:1660 E ROSEVILLE PKWY
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3988
Practice Address - Country:US
Practice Address - Phone:916-973-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94026909103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical