Provider Demographics
NPI:1770935579
Name:RUSSELL, SARA (BCBA)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MRS
Other - First Name:SARRA
Other - Middle Name:MALKA
Other - Last Name:RUSSEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS SP EDUCATION
Mailing Address - Street 1:556 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-4603
Mailing Address - Country:US
Mailing Address - Phone:646-584-5821
Mailing Address - Fax:
Practice Address - Street 1:556 E 5TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-4603
Practice Address - Country:US
Practice Address - Phone:646-584-5821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst