Basic Information
| Provider Information | |||||||||
| NPI: | 1427482405 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OU | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2150 PORTOLA AVE. | ||||||||
| Address2: | SUITE D #184 | ||||||||
| City: | LIVERMORE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108915600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2400 MOORPARK AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951282631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4089752730 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2013 | ||||||||
| LastUpdateDate: | 03/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 79893 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.