Healthcare Provider Details

I. General information

NPI: 1447926621
Provider Name (Legal Business Name): SAVANNAH CUDDY RMHCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 SW FEDERAL HWY
STUART FL
34994-2914
US

IV. Provider business mailing address

593 SW SAINT JOHNS BAY
PORT ST LUCIE FL
34986-3410
US

V. Phone/Fax

Practice location:
  • Phone: 772-281-0599
  • Fax:
Mailing address:
  • Phone: 561-403-6218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH26192
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-104102
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: