Healthcare Provider Details

I. General information

NPI: 1407636095
Provider Name (Legal Business Name): DEIRDRE ELIZABETH SABOW AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CAMINO ALTO
MILL VALLEY CA
94941-2929
US

IV. Provider business mailing address

45 CAMINO ALTO
MILL VALLEY CA
94941-2929
US

V. Phone/Fax

Practice location:
  • Phone: 415-216-3504
  • Fax:
Mailing address:
  • Phone: 415-216-3504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberAMFT140443
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: