Provider Demographics
NPI:1104457043
Name:TATUM, SAWYER (MS, BCBA)
Entity type:Individual
Prefix:
First Name:SAWYER
Middle Name:
Last Name:TATUM
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WARWICK RD
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836-4402
Mailing Address - Country:US
Mailing Address - Phone:973-223-7894
Mailing Address - Fax:
Practice Address - Street 1:19 WARWICK RD
Practice Address - Street 2:
Practice Address - City:FLANDERS
Practice Address - State:NJ
Practice Address - Zip Code:07836-4402
Practice Address - Country:US
Practice Address - Phone:973-223-7894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-19-38248103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst