Provider Demographics
NPI:1538563796
Name:ROLDAN PEDEN, SARAH (MS, BCBA)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:ROLDAN PEDEN
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 1:13086 83RD LN N
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33412-2671
Mailing Address - Country:US
Mailing Address - Phone:305-796-7342
Mailing Address - Fax:
Practice Address - Street 1:2115 10TH AVE N
Practice Address - Street 2:
Practice Address - City:LAKE WORTH BEACH
Practice Address - State:FL
Practice Address - Zip Code:33461-3345
Practice Address - Country:US
Practice Address - Phone:561-506-3665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program