Provider Demographics
NPI:1235612748
Name:MARINO, SARAH GAUTHIER (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:GAUTHIER
Last Name:MARINO
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 SHIRLEY RD
Mailing Address - Street 2:
Mailing Address - City:BUNKIE
Mailing Address - State:LA
Mailing Address - Zip Code:71322-1540
Mailing Address - Country:US
Mailing Address - Phone:318-346-9288
Mailing Address - Fax:
Practice Address - Street 1:855 SHIRLEY RD
Practice Address - Street 2:
Practice Address - City:BUNKIE
Practice Address - State:LA
Practice Address - Zip Code:71322-1540
Practice Address - Country:US
Practice Address - Phone:318-346-9288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-316103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst