Healthcare Provider Details

I. General information

NPI: 1295840726
Provider Name (Legal Business Name): SARAH MARIE PEMBERTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 TEMESCAL CANYON RD STE 309
CORONA CA
92883-4629
US

IV. Provider business mailing address

2420 RIVER RD STE 230
NORCO CA
92860-2271
US

V. Phone/Fax

Practice location:
  • Phone: 951-223-1120
  • Fax:
Mailing address:
  • Phone: 951-223-1120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25339
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: