Provider Demographics
NPI:1568102366
Name:PHILLIPS, SAVANNAH RAE
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:RAE
Last Name:PHILLIPS
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 1:11420 N KENDALL DR STE 112
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1039
Mailing Address - Country:US
Mailing Address - Phone:305-279-1999
Mailing Address - Fax:305-459-3270
Practice Address - Street 1:11420 N KENDALL DR STE 112
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1039
Practice Address - Country:US
Practice Address - Phone:305-279-1999
Practice Address - Fax:305-459-3270
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician