Basic Information
Provider Information
NPI: 1174962229
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROBINSON
FirstName: SAPPHIRE
MiddleName: MARIA
NamePrefix: MRS.
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: ROSIER
OtherFirstName: SAPPHIRE
OtherMiddleName: MARIA
OtherNamePrefix: MISS
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 350 S 400 E
Address2:  
City: SALT LAKE CITY
State: UT
PostalCode: 841112905
CountryCode: US
TelephoneNumber: 8015825534
FaxNumber: 8015825540
Practice Location
Address1: 350 S 400 E
Address2:  
City: SALT LAKE CITY
State: UT
PostalCode: 84111
CountryCode: US
TelephoneNumber: 8015825534
FaxNumber: 8015825540
Other Information
ProviderEnumerationDate: 06/21/2013
LastUpdateDate: 06/29/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XCSW.09924489CON Behavioral Health & Social Service ProvidersSocial WorkerClinical
1041S0200X203931CON Behavioral Health & Social Service ProvidersSocial WorkerSchool
1041C0700X8581524-3501UTY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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