Provider Demographics
NPI:1831523489
Name:BROCK CHAVEZ, SARAH ANITA (LCSW)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:ANITA
Last Name:BROCK CHAVEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ANITA BROCK
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:3620 LONG BEACH BLVD STE C8
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-6013
Mailing Address - Country:US
Mailing Address - Phone:310-943-1023
Mailing Address - Fax:
Practice Address - Street 1:3620 LONG BEACH BLVD STE C8
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-6013
Practice Address - Country:US
Practice Address - Phone:310-943-1023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA805061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor