Provider Demographics
NPI:1306196308
Name:SAVAGE, JUANITA LORETTE (CAS)
Entity Type:Individual
Prefix:MS
First Name:JUANITA
Middle Name:LORETTE
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2028
Mailing Address - Country:US
Mailing Address - Phone:415-459-2395
Mailing Address - Fax:415-459-1292
Practice Address - Street 1:1477 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2028
Practice Address - Country:US
Practice Address - Phone:415-459-2395
Practice Address - Fax:415-459-1292
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA03-049873101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)