Provider Demographics
NPI:1538564497
Name:KORNBLUH, SARAH (MS BCBA)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:KORNBLUH
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 1:705 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2571
Mailing Address - Country:US
Mailing Address - Phone:917-583-5107
Mailing Address - Fax:
Practice Address - Street 1:705 N LAKE DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-2571
Practice Address - Country:US
Practice Address - Phone:917-583-5107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHBACB259552103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst