Provider Demographics
NPI:1184778391
Name:SAGE, MARK A (MA, LMFT)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:SAGE
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:A
Other - Last Name:SAGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:315 S BEVERLY DR
Mailing Address - Street 2:307
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4312
Mailing Address - Country:US
Mailing Address - Phone:310-553-3924
Mailing Address - Fax:
Practice Address - Street 1:315 S BEVERLY DR
Practice Address - Street 2:307
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4312
Practice Address - Country:US
Practice Address - Phone:310-553-3924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38459106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist