Provider Demographics
NPI:1962584458
Name:SAWAMURA, ELLEN MIWAKO (PHD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:MIWAKO
Last Name:SAWAMURA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-2505
Mailing Address - Country:US
Mailing Address - Phone:415-392-4453
Mailing Address - Fax:415-433-0953
Practice Address - Street 1:720 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-2505
Practice Address - Country:US
Practice Address - Phone:415-392-4453
Practice Address - Fax:415-433-0953
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18673103TC0700X
CALCS 44751041C0700X
CAMFC 14048106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist