Provider Demographics
NPI:1083940316
Name:COURTNEY, SARAH (MA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:COURTNEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:225 S SWOOPE AVE
Mailing Address - Street 2:STE. 211
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:225 S SWOOPE AVE
Practice Address - Street 2:STE. 211
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5704
Practice Address - Country:US
Practice Address - Phone:407-622-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
1-13-13649103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health