Provider Demographics
NPI:1962396853
Name:MOORE, SARA MCNEIL (RBT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:MCNEIL
Last Name:MOORE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 MARTISA RD NW
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-4736
Mailing Address - Country:US
Mailing Address - Phone:850-999-3393
Mailing Address - Fax:
Practice Address - Street 1:103 RICKEY AVE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-2520
Practice Address - Country:US
Practice Address - Phone:850-376-5624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-4742-970219106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician