Provider Demographics
NPI:1255725362
Name:KUTRUMBOS, SARAH JANE CELLA (LMFT)
Entity type:Individual
Prefix:
First Name:SARAH JANE
Middle Name:CELLA
Last Name:KUTRUMBOS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JANE
Other - Last Name:CELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:4106 MCLAUGHLIN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-5400
Mailing Address - Country:US
Mailing Address - Phone:203-216-4020
Mailing Address - Fax:
Practice Address - Street 1:4620 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5408
Practice Address - Country:US
Practice Address - Phone:203-216-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAUNLICENSED106H00000X
390200000X
CA105989106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program