Healthcare Provider Details

I. General information

NPI: 1760309488
Provider Name (Legal Business Name): SAVANNAH SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 SILVER SPRING BLVD
KUNKLETOWN PA
18058-7108
US

IV. Provider business mailing address

356 SILVER SPRING BLVD
KUNKLETOWN PA
18058-7108
US

V. Phone/Fax

Practice location:
  • Phone: 757-352-1019
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH006726
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: