Provider Demographics
NPI:1932841418
Name:RUSSO, SARAH (BCBA)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:RUSSO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1166 E DAYTON YELLOW SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-6324
Mailing Address - Country:US
Mailing Address - Phone:207-814-8542
Mailing Address - Fax:207-261-1124
Practice Address - Street 1:7264 COLUMBIA RD STE 1000
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45039-8086
Practice Address - Country:US
Practice Address - Phone:513-402-1711
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-22-58528103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst