Provider Demographics
NPI:1194087247
Name:BOKARIUS-SNOW, SHARON S (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:S
Last Name:BOKARIUS-SNOW
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S ELLSWORTH AVE STE 511
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3929
Mailing Address - Country:US
Mailing Address - Phone:510-323-2524
Mailing Address - Fax:
Practice Address - Street 1:3260 BLUME DR STE 450
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-5115
Practice Address - Country:US
Practice Address - Phone:510-323-2524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22492103TC0700X
PSY 22492103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy