Provider Demographics
NPI:1083464028
Name:INGOLD, SAVANNAH SUMMER (ASW)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:SUMMER
Last Name:INGOLD
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 RIVER RUN DR UNIT 142
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-5823
Mailing Address - Country:US
Mailing Address - Phone:909-205-0814
Mailing Address - Fax:
Practice Address - Street 1:2423 CAMINO DEL RIO S STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3734
Practice Address - Country:US
Practice Address - Phone:619-241-2309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1201981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical