Healthcare Provider Details

I. General information

NPI: 1295629210
Provider Name (Legal Business Name): SALLY HOWARD PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 STRATFORD AVE
SOUTH PASADENA CA
91030-3412
US

IV. Provider business mailing address

1040 STRATFORD AVE
SOUTH PASADENA CA
91030-3412
US

V. Phone/Fax

Practice location:
  • Phone: 626-379-1357
  • Fax:
Mailing address:
  • Phone: 626-379-1357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberPSY10922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: