Provider Demographics
NPI:1497274682
Name:WOMACK, SARAH LYNNE (RBT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNNE
Last Name:WOMACK
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21310 DIAMONTE DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34637-7583
Mailing Address - Country:US
Mailing Address - Phone:813-495-3489
Mailing Address - Fax:
Practice Address - Street 1:21310 DIAMONTE DR
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34637-7583
Practice Address - Country:US
Practice Address - Phone:813-495-3489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician