1962988063 NPI number — SAVANNAH JOSEPH M.ED, BCBA, LBA

Table of content: SAVANNAH JOSEPH M.ED, BCBA, LBA (NPI 1962988063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962988063 NPI number — SAVANNAH JOSEPH M.ED, BCBA, LBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOSEPH
Provider First Name:
SAVANNAH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED, BCBA, LBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROVIRA
Provider Other First Name:
SAVANNAH
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED, BCBA, LBA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962988063
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18040 DERBES DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COVINGTON
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70433-0337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-237-8896
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 JACKSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANDEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70448-5328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-231-7612
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-18-31056 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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