Healthcare Provider Details

I. General information

NPI: 1952232837
Provider Name (Legal Business Name): SARA SIMONE AMOS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6340 SECURITY BLVD STE 100
GWYNN OAK MD
21207-5284
US

IV. Provider business mailing address

6340 SECURITY BLVD STE 100
GWYNN OAK MD
21207-5284
US

V. Phone/Fax

Practice location:
  • Phone: 216-236-9004
  • Fax:
Mailing address:
  • Phone: 216-236-9004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number25-480851
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: