Provider Demographics
NPI:1275684235
Name:GIANINO, SARA LAUREN (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LAUREN
Last Name:GIANINO
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13300 ATLANTIC BLVD APT 823
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-6114
Mailing Address - Country:US
Mailing Address - Phone:772-480-5904
Mailing Address - Fax:
Practice Address - Street 1:13300 ATLANTIC BLVD APT 823
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-6114
Practice Address - Country:US
Practice Address - Phone:772-480-5904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-10-1782103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL766647100Medicaid