Sarah Penkethman
Individual provider Active NPI Behavior Technician · Larkfield, CA
NPI 1982189098 · NPPES record last updated Sep 25, 2018
Key facts
- NPI
- 1982189098
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- License
- RBT-18-64923 (CA)
- Practice address
- 160 Wikiup Dr Ste 102
Larkfield, CA 95403-7776 - Phone
- (707) 308-2120
- NPI assigned
- Sep 25, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-18-64923 | CA | MD | Behavior Technician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-18-64923 | CA | Yes |
Addresses
Primary practice location
160 Wikiup Dr Ste 102
Larkfield, CA 95403-7776
Mailing address
160 Wikiup Dr Ste 102
Larkfield, CA 95403-7776
Phone (707) 308-2120
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 25, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.