Provider Demographics
NPI:1770822421
Name:LICHTENBERGER, SARAH NICOLE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:NICOLE
Last Name:LICHTENBERGER
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4374 HEMMINGWAY DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-2471
Mailing Address - Country:US
Mailing Address - Phone:336-327-9114
Mailing Address - Fax:
Practice Address - Street 1:4374 HEMMINGWAY DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2471
Practice Address - Country:US
Practice Address - Phone:336-327-9114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1.12.11926103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst