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General NPI Number Information
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NPI Number | 1114084803
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Entity Type | Individual
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Provider Name | SARI HERMINE DWORKIN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 1985 JOHNSON AVE
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-4131
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Country | US
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Telephone | 559-930-1747
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Fax | 805-773-5427
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Provider Business Mailing Address
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Address Line | 791 PRICE ST # 166
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City | PISMO BEACH
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State | CA
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Zip | 93449-2529
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Country | US
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Telephone | 559-930-1747
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Fax | 805-773-5427
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC23370
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 13852
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License Number State | CA
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