MEDICARE: DR. ANNE C SARAVO PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	PSY1066	SC
2	103TC0700X	Clinical Psychologist	PSY1066	SC
3	103TC0700X	Clinical Psychologist	PSY003031	GA

General Provider Information

NPI Number	:	1104091404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNE C SARAVO PHD

Provider Business Mailing Address
First Line	:	219 SCOTTS ST #351
Second Line	:
City	:	BEAUFORT
State	:	SC
Zip	:	29902-5554
Country	:	US
Telephone Number	:	843-263-2961
Fax Number	:	843-838-9928

Provider Business Practice Location Address
First Line	:	1460 GLEASONS LANDING DR
Second Line	:
City	:	ST HELENA ISLAND
State	:	SC
Zip	:	29920-3814
Country	:	US
Telephone Number	:	843-838-9998
Fax Number	:	843-838-9929

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	04/28/2008

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