Provider Demographics
NPI:1770874067
Name:BARRON, SARAH RUTH BANKA (PHD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:RUTH BANKA
Last Name:BARRON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:RUTH
Other - Last Name:BANKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:10000 BAY PINES BLVD
Mailing Address - Street 2:PO BOX 5005 (116C)
Mailing Address - City:BAY PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33744-8200
Mailing Address - Country:US
Mailing Address - Phone:727-398-6661
Mailing Address - Fax:
Practice Address - Street 1:10000 BAY PINES BLVD
Practice Address - Street 2:BLDG 102 (DOMC)
Practice Address - City:BAY PINES
Practice Address - State:FL
Practice Address - Zip Code:33744-8200
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID202558103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical