Provider Demographics
NPI:1346817228
Name:PETTIT, SARA MARIE (BCBA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MARIE
Last Name:PETTIT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1004
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-6004
Mailing Address - Country:US
Mailing Address - Phone:860-946-0362
Mailing Address - Fax:
Practice Address - Street 1:24 STONY HILL RD LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-1166
Practice Address - Country:US
Practice Address - Phone:860-946-0362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-20-44432103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst