Provider Demographics
NPI:1942848791
Name:NEITZ, SASHA ROSE (BA)
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:ROSE
Last Name:NEITZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:SASHA
Other - Middle Name:ROSE
Other - Last Name:DALLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:444 GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-6005
Mailing Address - Country:US
Mailing Address - Phone:415-756-9547
Mailing Address - Fax:
Practice Address - Street 1:444 GEORGIA ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-6005
Practice Address - Country:US
Practice Address - Phone:707-563-0157
Practice Address - Fax:707-638-0421
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician