Provider Demographics
NPI:1205176120
Name:TESKE, SARAH (BCBA)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:TESKE
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 1:94 BEECH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ELIOT
Mailing Address - State:ME
Mailing Address - Zip Code:03903-1602
Mailing Address - Country:US
Mailing Address - Phone:603-738-8344
Mailing Address - Fax:
Practice Address - Street 1:94 BEECH RIDGE RD
Practice Address - Street 2:
Practice Address - City:ELIOT
Practice Address - State:ME
Practice Address - Zip Code:03903-1602
Practice Address - Country:US
Practice Address - Phone:603-738-8344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-07-3383103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-07-3383OtherBEHAVIOR ANALYST CERTIFICATION BOARD