Healthcare Provider Details

I. General information

NPI: 1942708292
Provider Name (Legal Business Name): SARA RUTH PASSARO LICSW, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7507 HOGARTH ST
SPRINGFIELD VA
22151-2916
US

IV. Provider business mailing address

7507 HOGARTH ST
SPRINGFIELD VA
22151-2916
US

V. Phone/Fax

Practice location:
  • Phone: 609-549-1013
  • Fax:
Mailing address:
  • Phone: 609-549-1013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC200004003
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-41342
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-48009
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: