Provider Demographics
NPI:1194312769
Name:TAL, SARA
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:TAL
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:TERMINIELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:708 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3018
Mailing Address - Country:US
Mailing Address - Phone:908-415-8118
Mailing Address - Fax:
Practice Address - Street 1:708 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3018
Practice Address - Country:US
Practice Address - Phone:908-415-8118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156F00000X
NJ1-21-56398103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No156F00000XEye and Vision Services ProvidersTechnician/Technologist