Provider Demographics
NPI:1316461411
Name:LANTZMAN, SARAH FISHKIND (BS, BCABA)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:FISHKIND
Last Name:LANTZMAN
Suffix:
Gender:F
Credentials:BS, BCABA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:FISHKIND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1698 HIGHWAY 160 W STE 240
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8035
Mailing Address - Country:US
Mailing Address - Phone:704-654-8599
Mailing Address - Fax:336-642-0384
Practice Address - Street 1:1698 HIGHWAY 160 W STE 240
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8035
Practice Address - Country:US
Practice Address - Phone:704-654-8599
Practice Address - Fax:336-642-0384
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-31
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019689100Medicaid