Healthcare Provider Details

I. General information

NPI: 1538563796
Provider Name (Legal Business Name): SARAH ROLDAN PEDEN MS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 10TH AVE N
LAKE WORTH BEACH FL
33461-3345
US

IV. Provider business mailing address

13086 83RD LN N
WEST PALM BEACH FL
33412-2671
US

V. Phone/Fax

Practice location:
  • Phone: 561-506-3665
  • Fax:
Mailing address:
  • Phone: 305-796-7342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: