Provider Demographics
NPI:1902622756
Name:AMBURN, SARAH (MA, CAS)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:AMBURN
Suffix:
Gender:F
Credentials:MA, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5422 KILLINGWORTH WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1816
Mailing Address - Country:US
Mailing Address - Phone:443-465-6303
Mailing Address - Fax:
Practice Address - Street 1:200 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-5984
Practice Address - Country:US
Practice Address - Phone:410-396-3426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool