Provider Demographics
NPI:1922851047
Name:SHORT, SAVANNAH DIMPNA (INTERN MASTER'S LEVE)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:DIMPNA
Last Name:SHORT
Suffix:
Gender:F
Credentials:INTERN MASTER'S LEVE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 ASPEN PL
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-2036
Mailing Address - Country:US
Mailing Address - Phone:916-591-4668
Mailing Address - Fax:
Practice Address - Street 1:4001 OFFICE COURT DRIVER STE 102
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4903
Practice Address - Country:US
Practice Address - Phone:505-395-9437
Practice Address - Fax:505-930-5427
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health