Healthcare Provider Details

I. General information

NPI: 1932937513
Provider Name (Legal Business Name): SORRENTA STUART LMFT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/24/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 PINE ST STE 100
WALNUT CREEK CA
94596-3633
US

IV. Provider business mailing address

260 SUMMIT RD
WALNUT CREEK CA
94598-4730
US

V. Phone/Fax

Practice location:
  • Phone: 925-963-5353
  • Fax:
Mailing address:
  • Phone: 925-963-5353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: SORRENTA CHANTEL STUART
Title or Position: OWNER
Credential: LMFT
Phone: 925-963-5353