Provider Demographics
NPI:1487787636
Name:MANGAT, SARABJIT (PSYD)
Entity type:Individual
Prefix:
First Name:SARABJIT
Middle Name:
Last Name:MANGAT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30101 AGOURA CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AGOURA
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4300
Mailing Address - Country:US
Mailing Address - Phone:310-991-5401
Mailing Address - Fax:
Practice Address - Street 1:3625 E THOUSAND OAKS BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3626
Practice Address - Country:US
Practice Address - Phone:310-991-5401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22651103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical