Healthcare Provider Details

I. General information

NPI: 1427780477
Provider Name (Legal Business Name): SARA CHAMBERLIN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5885 BROCKTON AVE
RIVERSIDE CA
92506-1863
US

IV. Provider business mailing address

9246 LIGHTWAVE AVE STE 120
SAN DIEGO CA
92123-6411
US

V. Phone/Fax

Practice location:
  • Phone: 800-270-5016
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number36733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: