Healthcare Provider Details

I. General information

NPI: 1700388451
Provider Name (Legal Business Name): SARA T AVRATIN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1539 W GARVEY AVE N
WEST COVINA CA
91790-2139
US

IV. Provider business mailing address

670 W SAN JOSE AVE APT 17
CLAREMONT CA
91711-5410
US

V. Phone/Fax

Practice location:
  • Phone: 626-960-4844
  • Fax:
Mailing address:
  • Phone: 909-964-4683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number124342
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: