Provider Demographics
NPI:1699399089
Name:SAMUEL, SABRENA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:SABRENA
Middle Name:
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7106 BALMY DEW WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1615
Mailing Address - Country:US
Mailing Address - Phone:434-960-1260
Mailing Address - Fax:
Practice Address - Street 1:7106 BALMY DEW WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1615
Practice Address - Country:US
Practice Address - Phone:434-960-1260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2020-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst