Provider Demographics
NPI:1891440707
Name:DEROMA, SAVANNAH (AMFT)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:
Last Name:DEROMA
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7572 CHARMANT DR APT 223
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5068
Mailing Address - Country:US
Mailing Address - Phone:571-269-1072
Mailing Address - Fax:
Practice Address - Street 1:4520 EXECUTIVE DR STE 225
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3094
Practice Address - Country:US
Practice Address - Phone:858-202-1822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist