Healthcare Provider Details

I. General information

NPI: 1144653981
Provider Name (Legal Business Name): SARAH PORTER VERNON BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 02/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1474 E LEBANON RD
DOVER DE
19901-5833
US

IV. Provider business mailing address

10879 BENTWATER LN
FISHERS IN
46037-9384
US

V. Phone/Fax

Practice location:
  • Phone: 302-244-3404
  • Fax:
Mailing address:
  • Phone: 513-520-9317
  • Fax: 317-842-5911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: