Provider Demographics
NPI:1770986382
Name:DAUGHERTY, SARA (MS BCBA)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:MS BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5004 HONEYGO CENTER DR
Mailing Address - Street 2:SUITE 102-115
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-8963
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5004 HONEYGO CENTER DR
Practice Address - Street 2:SUITE 102-115
Practice Address - City:PERRY HALL
Practice Address - State:MD
Practice Address - Zip Code:21128-8963
Practice Address - Country:US
Practice Address - Phone:888-344-5977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-28
Last Update Date:2014-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst