Provider Demographics
NPI:1861414765
Name:SORRENTINO, THERESE (LMFT)
Entity type:Individual
Prefix:MS
First Name:THERESE
Middle Name:
Last Name:SORRENTINO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15454
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95851-0454
Mailing Address - Country:US
Mailing Address - Phone:916-396-4688
Mailing Address - Fax:916-921-6653
Practice Address - Street 1:418 ALHAMBRA BLVD BLDG A
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3362
Practice Address - Country:US
Practice Address - Phone:916-396-4688
Practice Address - Fax:916-921-6653
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35160106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist