Provider Demographics
NPI:1750934378
Name:SIEG, SARAH ELIZABETH (BCBA)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:SIEG
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 1:1725 MERCERS FERNERY RD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-2166
Mailing Address - Country:US
Mailing Address - Phone:386-804-2557
Mailing Address - Fax:
Practice Address - Street 1:247 W VOORHIS AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-5432
Practice Address - Country:US
Practice Address - Phone:386-795-5695
Practice Address - Fax:386-777-3850
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-19-37744103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst