Provider Demographics
NPI:1609376037
Name:CHURCH, SARAH (BCBA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:CHURCH
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 1:140 UWAPO RD APT 60-201
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-7423
Mailing Address - Country:US
Mailing Address - Phone:128-209-7153
Mailing Address - Fax:
Practice Address - Street 1:140 UWAPO RD APT 60-201
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7423
Practice Address - Country:US
Practice Address - Phone:128-209-7153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst