Healthcare Provider Details

I. General information

NPI: 1952439382
Provider Name (Legal Business Name): SARAH CARPENTER LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SILICON VALLEY BLVD
SAN JOSE CA
95138-1858
US

IV. Provider business mailing address

10880 NEW AVE APT B
GILROY CA
95020-9343
US

V. Phone/Fax

Practice location:
  • Phone: 408-284-9081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT 30934
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: