Healthcare Provider Details

I. General information

NPI: 1982054284
Provider Name (Legal Business Name): SARA POULIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CAMBRIDGE ST STE 1400
BOSTON MA
02114-2545
US

IV. Provider business mailing address

39704 COIT RD
DADE CITY FL
33523-9783
US

V. Phone/Fax

Practice location:
  • Phone: 617-639-1025
  • Fax:
Mailing address:
  • Phone: 646-894-8380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-43229
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: