Provider Demographics
NPI:1962055103
Name:BROWN, SARAH JUNG-MI (LCSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JUNG-MI
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JUNG-MI
Other - Last Name:CANAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14665 WASHINGTON AVE APT 34
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-4231
Mailing Address - Country:US
Mailing Address - Phone:510-712-1033
Mailing Address - Fax:
Practice Address - Street 1:975 SCHAFER RD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-3614
Practice Address - Country:US
Practice Address - Phone:510-723-3835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1249801041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool