Provider Demographics
NPI:1588081418
Name:SADEWATER, KAREN LYNNETTE
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNNETTE
Last Name:SADEWATER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14068 GRAHAM ST STE 202
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-8830
Mailing Address - Country:US
Mailing Address - Phone:951-649-9385
Mailing Address - Fax:
Practice Address - Street 1:17862 17TH ST STE 107
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2170
Practice Address - Country:US
Practice Address - Phone:146-615-3907
Practice Address - Fax:714-661-5449
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT106026106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33-0282137Medicare PIN