Provider Demographics
NPI:1366861072
Name:PRIDONOFF, SARAH (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:PRIDONOFF
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:SHIR
Other - Middle Name:
Other - Last Name:PRIDONOFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, BCBA
Mailing Address - Street 1:3601 N AVIATION BLVD
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-3753
Mailing Address - Country:US
Mailing Address - Phone:310-406-1500
Mailing Address - Fax:310-406-1531
Practice Address - Street 1:3601 N AVIATION BLVD
Practice Address - Street 2:SUITE 2200
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-3753
Practice Address - Country:US
Practice Address - Phone:310-406-1500
Practice Address - Fax:310-406-1531
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-14008103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst