Provider Demographics
NPI:1487257200
Name:LAWSON, SARAH NOELLE
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:NOELLE
Last Name:LAWSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:NOELLE
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11751 SE 72ND COURT RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-4616
Mailing Address - Country:US
Mailing Address - Phone:863-521-0207
Mailing Address - Fax:
Practice Address - Street 1:11751 SE 72ND COURT RD
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-4616
Practice Address - Country:US
Practice Address - Phone:863-521-0207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS1440103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool