Provider Demographics
NPI:1669190682
Name:BRIDGES, SARA (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16325 MARSHA ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1244
Mailing Address - Country:US
Mailing Address - Phone:734-788-6897
Mailing Address - Fax:
Practice Address - Street 1:16635 RIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-9530
Practice Address - Country:US
Practice Address - Phone:734-788-6897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-22-58254103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst