Provider Demographics
NPI:1750898516
Name:SAGE, RACHELE ELIZABETH (BCBA)
Entity type:Individual
Prefix:
First Name:RACHELE
Middle Name:ELIZABETH
Last Name:SAGE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:RACHELE
Other - Middle Name:
Other - Last Name:MADDOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 KNOLLWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:FT. WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548
Mailing Address - Country:US
Mailing Address - Phone:850-803-2562
Mailing Address - Fax:
Practice Address - Street 1:139 BEAL PKWY SE UNIT 107
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5343
Practice Address - Country:US
Practice Address - Phone:850-803-2562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-02
Last Update Date:2021-08-24
Deactivation Date:2021-05-20
Deactivation Code:
Reactivation Date:2021-06-25
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician