Provider Demographics
NPI:1215725627
Name:NEELY, SARAH (EDD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:NEELY
Suffix:
Gender:
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 N VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95203-2429
Mailing Address - Country:US
Mailing Address - Phone:209-662-4335
Mailing Address - Fax:
Practice Address - Street 1:2800 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-3757
Practice Address - Country:US
Practice Address - Phone:209-662-4335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-26
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94028269103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical