Provider Demographics
NPI:1063536241
Name:CRAIN, SARA L (MA, MFT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:L
Last Name:CRAIN
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1271 WASHINGTON AVE STE 919
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-3646
Mailing Address - Country:US
Mailing Address - Phone:925-284-6987
Mailing Address - Fax:
Practice Address - Street 1:2416-A CENTRAL AVE.
Practice Address - Street 2:SUITE B
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4516
Practice Address - Country:US
Practice Address - Phone:925-284-6987
Practice Address - Fax:888-297-6166
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44479106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA680301516OtherEMPLOYER'S TAX ID # (TIN)