Provider Demographics
NPI:1326650672
Name:HOLLENBACK, SARAH MARY
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MARY
Last Name:HOLLENBACK
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 1:535 SANDY ST
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-5158
Mailing Address - Country:US
Mailing Address - Phone:570-807-0031
Mailing Address - Fax:
Practice Address - Street 1:535 SANDY ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-5158
Practice Address - Country:US
Practice Address - Phone:570-807-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BH004980103K00000X
PACW0168081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical