Provider Demographics
NPI:1164071569
Name:NEW, SAVANNAH
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:
Last Name:NEW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35 WALPOLE ST STE 207
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-6546
Mailing Address - Country:US
Mailing Address - Phone:540-383-7133
Mailing Address - Fax:540-246-0717
Practice Address - Street 1:35 WALPOLE ST STE 207
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-6546
Practice Address - Country:US
Practice Address - Phone:540-383-7133
Practice Address - Fax:540-246-0717
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA106S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician