Provider Demographics
NPI:1750633467
Name:INGRASSIA, MEGAN ELIZABETH
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:INGRASSIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 WESTWIND BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1099
Mailing Address - Country:US
Mailing Address - Phone:707-565-5971
Mailing Address - Fax:
Practice Address - Street 1:3725 WESTWIND BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1099
Practice Address - Country:US
Practice Address - Phone:707-565-5971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker