Provider Demographics
NPI:1053855866
Name:BARRETT, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BARRETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3658 SUFFOLK DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-7125
Mailing Address - Country:US
Mailing Address - Phone:781-307-0129
Mailing Address - Fax:
Practice Address - Street 1:3505 CAMINO DEL RIO S STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4016
Practice Address - Country:US
Practice Address - Phone:888-616-0864
Practice Address - Fax:888-616-0864
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-18-54219106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-18-54219OtherBACB