Provider Demographics
NPI:1982860706
Name:ROSENBLUM-FISHMAN, SARA D (PHD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:D
Last Name:ROSENBLUM-FISHMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:ROSENBLUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:230 FUNSTON AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-2144
Mailing Address - Country:US
Mailing Address - Phone:516-445-6454
Mailing Address - Fax:
Practice Address - Street 1:5838 EDISON PL STE 100
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008
Practice Address - Country:US
Practice Address - Phone:760-300-3664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29104103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical