Healthcare Provider Details

I. General information

NPI: 1912103201
Provider Name (Legal Business Name): SARAH LAZARRE-BLOOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6355 TELEGRAPH AVE STE 202
OAKLAND CA
94609-1372
US

IV. Provider business mailing address

6355 TELEGRAPH AVE STE 202
OAKLAND CA
94609-1372
US

V. Phone/Fax

Practice location:
  • Phone: 510-655-1278
  • Fax:
Mailing address:
  • Phone: 510-655-1278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY29631
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: