Provider Demographics
NPI:1689645152
Name:SASSEN-CROY, SHARON RACHELLE (RBT)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:RACHELLE
Last Name:SASSEN-CROY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6428 OLD MEDINAH CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-7338
Mailing Address - Country:US
Mailing Address - Phone:754-213-2022
Mailing Address - Fax:
Practice Address - Street 1:6428 OLD MEDINAH CIR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-7338
Practice Address - Country:US
Practice Address - Phone:754-213-2022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-319481106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA222475OtherCOVENTRY HEALTH CARE
IA0435511Medicaid
IAP00028845OtherRAILROAD MEDICARE
IAU81896Medicare UPIN
IA22073OtherWELLMARK BLUE CROSS
IAI0482Medicare ID - Type Unspecified