Provider Demographics
NPI:1972368868
Name:ESPINOZA, SARAH ANDREA (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANDREA
Last Name:ESPINOZA
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ANDREA
Other - Last Name:AREVALO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, BCBA, LBA
Mailing Address - Street 1:PO BOX 86537
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85754-6537
Mailing Address - Country:US
Mailing Address - Phone:520-721-1887
Mailing Address - Fax:520-372-7126
Practice Address - Street 1:401 N BONITA AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2750
Practice Address - Country:US
Practice Address - Phone:520-721-1887
Practice Address - Fax:520-618-6653
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-001434103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ185355Medicaid