Healthcare Provider Details

I. General information

NPI: 1255725362
Provider Name (Legal Business Name): SARAH JANE CELLA KUTRUMBOS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH JANE CELLA LMFT

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620 HOLLYWOOD BLVD
LOS ANGELES CA
90027-5408
US

IV. Provider business mailing address

4106 MCLAUGHLIN AVE APT 1
LOS ANGELES CA
90066-5400
US

V. Phone/Fax

Practice location:
  • Phone: 203-216-4020
  • Fax:
Mailing address:
  • Phone: 203-216-4020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberUNLICENSED
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number105989
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: