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General NPI Number Information
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NPI Number | 1396888954
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Entity Type | Individual
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Provider Name | THEODORE E. SACHS MSW
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Gender | Male
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 01/17/2022
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Provider Practice Location Address
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Address Line | 1550 GATEWAY BLVD
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City | FAIRFIELD
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State | CA
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Zip | 94533-6901
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Country | US
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Telephone | 707-427-4472
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Fax |
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Provider Business Mailing Address
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Address Line | 1753 DEVONSHIRE DR
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City | BENICIA
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State | CA
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Zip | 94510-1727
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Country | US
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Telephone | 707-427-4472
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS15782
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License Number State | CA
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