Healthcare Provider Details

I. General information

NPI: 1326650672
Provider Name (Legal Business Name): SARAH MARY JENSEN MS, LBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 STARK ST
PITTSTON PA
18640-2026
US

IV. Provider business mailing address

429 HEMLOCK ST
JERMYN PA
18433-1205
US

V. Phone/Fax

Practice location:
  • Phone: 272-293-2000
  • Fax:
Mailing address:
  • Phone: 570-807-0031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH004980
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: