Healthcare Provider Details

I. General information

NPI: 1013526664
Provider Name (Legal Business Name): SARAH ANNE NOVICKIS PHD, LP, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH ANNE ENGEL

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 10/10/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 GREEN ST
HONOLULU HI
96813-2119
US

IV. Provider business mailing address

710 GREEN ST
HONOLULU HI
96813-2119
US

V. Phone/Fax

Practice location:
  • Phone: 808-536-1015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA-405
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-2082
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: