Provider Demographics
NPI:1639516800
Name:FUSILIER, SARA BETH (BS)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:BETH
Last Name:FUSILIER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 MICCOSUKEE COMMONS DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5456
Mailing Address - Country:US
Mailing Address - Phone:850-264-1355
Mailing Address - Fax:888-873-4610
Practice Address - Street 1:1815 MICCOSUKEE COMMONS DR
Practice Address - Street 2:SUITE 102
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5456
Practice Address - Country:US
Practice Address - Phone:850-264-1355
Practice Address - Fax:888-873-4610
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst