Provider Demographics
NPI:1235601725
Name:LEE, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:LEE
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 1:6949 DEW POINT WAY
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1865
Mailing Address - Country:US
Mailing Address - Phone:909-317-8499
Mailing Address - Fax:
Practice Address - Street 1:6949 DEW POINT WAY
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-1865
Practice Address - Country:US
Practice Address - Phone:909-317-8499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00002502106S00000X
CA1-21-47694103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00002502OtherBOARD CERTIFIED AUTISM TECHNICIAN