Provider Demographics
NPI:1225761836
Name:BRADY, SAVANNA LEIGH
Entity Type:Individual
Prefix:MS
First Name:SAVANNA
Middle Name:LEIGH
Last Name:BRADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 COUNTRY CLUB DR SE APT F201
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-2259
Mailing Address - Country:US
Mailing Address - Phone:505-238-3338
Mailing Address - Fax:
Practice Address - Street 1:900 COUNTRY CLUB DR SE APT F201
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-2259
Practice Address - Country:US
Practice Address - Phone:505-238-3338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician