MEDICARE: MS. SARAH CHURCH PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY23209	CA

General Provider Information

NPI Number	:	1881897650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARAH CHURCH PSYD

Provider Business Mailing Address
First Line	:	12021 WILMINGTON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90059-3019
Country	:	US
Telephone Number	:	132-305-4189
Fax Number	:

Provider Business Practice Location Address
First Line	:	12021 WILMINGTON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90059-3019
Country	:	US
Telephone Number	:	310-534-1083
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	01/27/2025

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