Basic Information
| Provider Information | |||||||||
| NPI: | 1245462209 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUESNELL | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | CATHERINE | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 454 LAS GALLINAS AVE | ||||||||
| Address2: | PMB 2016 | ||||||||
| City: | SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105354000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 454 LAS GALLINAS AVE | ||||||||
| Address2: | #2016 | ||||||||
| City: | SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7076411900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2009 | ||||||||
| LastUpdateDate: | 06/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 29320 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.