Healthcare Provider Details

I. General information

NPI: 1801210158
Provider Name (Legal Business Name): SARAH TUBERMAN-GREEN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25550 HAWTHORNE BLVD STE 200
TORRANCE CA
90505-6832
US

IV. Provider business mailing address

25550 HAWTHORNE BLVD STE 200
TORRANCE CA
90505-6832
US

V. Phone/Fax

Practice location:
  • Phone: 818-645-9028
  • Fax:
Mailing address:
  • Phone: 424-999-4789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY32685
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY32685
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPSY32685
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY32685
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: