Healthcare Provider Details

I. General information

NPI: 1114610136
Provider Name (Legal Business Name): SAVANNAH MARIE CIPRIANO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13805 ANN PL
AUSTIN TX
78728-7702
US

IV. Provider business mailing address

13805 ANN PL
AUSTIN TX
78728-7702
US

V. Phone/Fax

Practice location:
  • Phone: 469-612-3284
  • Fax:
Mailing address:
  • Phone: 469-612-3284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number68446
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: