Provider Demographics
NPI:1003408600
Name:VASQUEZ, SAVANNAH (BCBA)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 IVY GREEN LN SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-3935
Mailing Address - Country:US
Mailing Address - Phone:404-823-8149
Mailing Address - Fax:
Practice Address - Street 1:2110 MOON STATION DR NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2759
Practice Address - Country:US
Practice Address - Phone:770-339-3475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst