Healthcare Provider Details

I. General information

NPI: 1245002047
Provider Name (Legal Business Name): SARAH GOMOLIN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH FREEDMAN BCBA

II. Dates (important events)

Enumeration Date: 10/25/2023
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 RIVER AVE
LAKEWOOD NJ
08701-5659
US

IV. Provider business mailing address

936 MADISON AVE
LAKEWOOD NJ
08701-2626
US

V. Phone/Fax

Practice location:
  • Phone: 732-833-3723
  • Fax:
Mailing address:
  • Phone: 561-531-1192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-67977
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: