Provider Demographics
NPI:1982946620
Name:NEVIUS, SARA
Entity type:Individual
Prefix:MISS
First Name:SARA
Middle Name:
Last Name:NEVIUS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:MUNKRES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1160 BRICKYARD COVE RD STE 111
Mailing Address - Street 2:
Mailing Address - City:PT RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-4112
Mailing Address - Country:US
Mailing Address - Phone:510-942-3507
Mailing Address - Fax:
Practice Address - Street 1:1160 BRICKYARD COVE RD STE 111
Practice Address - Street 2:
Practice Address - City:PT RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-4112
Practice Address - Country:US
Practice Address - Phone:510-942-3507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 101YM0800X, 1041C0700X, 172V00000X
CA116809104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No172V00000XOther Service ProvidersCommunity Health Worker