Provider Demographics
NPI:1063795532
Name:SAGE PSYCHOTHERAPY ASSOCIATES, AN INDIVIDUAL, MARRIAGE AND FAMILY THER
Entity type:Organization
Organization Name:SAGE PSYCHOTHERAPY ASSOCIATES, AN INDIVIDUAL, MARRIAGE AND FAMILY THER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-614-9200
Mailing Address - Street 1:601 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6775
Mailing Address - Country:US
Mailing Address - Phone:916-614-9200
Mailing Address - Fax:916-614-9201
Practice Address - Street 1:601 UNIVERSITY AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6775
Practice Address - Country:US
Practice Address - Phone:916-614-9200
Practice Address - Fax:916-614-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37167106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty