Provider Demographics
NPI:1679809073
Name:RICHARDSON, SARA (MS/BCBA)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MS/BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8930 CARIBBEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-7147
Mailing Address - Country:US
Mailing Address - Phone:305-812-0188
Mailing Address - Fax:305-256-9935
Practice Address - Street 1:18495 S DIXIE HWY # 345
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6817
Practice Address - Country:US
Practice Address - Phone:305-812-0188
Practice Address - Fax:305-256-9935
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-09-5292103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst