Provider Demographics
NPI:1841912201
Name:RISLEY, SARAH JANE
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JANE
Last Name:RISLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2379 VINTAGE DR
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6089
Mailing Address - Country:US
Mailing Address - Phone:708-646-6814
Mailing Address - Fax:
Practice Address - Street 1:916 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-6416
Practice Address - Country:US
Practice Address - Phone:954-643-6033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-25-82748103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst