Provider Demographics
NPI:1194330266
Name:YASSIN, SARAH (PSYCH D)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:YASSIN
Suffix:
Gender:F
Credentials:PSYCH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6677 W THUNDERBIRD RD STE D148
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3769
Mailing Address - Country:US
Mailing Address - Phone:602-843-3811
Mailing Address - Fax:602-843-0044
Practice Address - Street 1:6677 W THUNDERBIRD RD STE D148
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3769
Practice Address - Country:US
Practice Address - Phone:602-843-3811
Practice Address - Fax:602-843-0044
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005225103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPSY-005225OtherSTATE LICENSE