Provider Demographics
NPI:1790517985
Name:HAJJAR, SARINE MARY
Entity type:Individual
Prefix:
First Name:SARINE
Middle Name:MARY
Last Name:HAJJAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19146 MERION DR
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-1835
Mailing Address - Country:US
Mailing Address - Phone:818-624-7737
Mailing Address - Fax:
Practice Address - Street 1:19146 MERION DR
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-1835
Practice Address - Country:US
Practice Address - Phone:818-624-7737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-20-122753106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician