Healthcare Provider Details

I. General information

NPI: 1437539574
Provider Name (Legal Business Name): SARA R TAFT BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 WASHINGTON ST NE
ALBUQUERQUE NM
87113-1846
US

IV. Provider business mailing address

8500 WASHINGTON ST NE
ALBUQUERQUE NM
87113-1846
US

V. Phone/Fax

Practice location:
  • Phone: 505-828-3837
  • Fax:
Mailing address:
  • Phone: 505-828-3827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: