Provider Demographics
NPI:1073674974
Name:PATERNO, ROXANNE JOHNSON (LCSW)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:JOHNSON
Last Name:PATERNO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ROXANNE
Other - Middle Name:MARIE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2101 COURAGE DR
Mailing Address - Street 2:MAIL STATION 10-300
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6717
Mailing Address - Country:US
Mailing Address - Phone:707-784-2150
Mailing Address - Fax:707-784-2103
Practice Address - Street 1:2101 COURAGE DR
Practice Address - Street 2:MAIL STATION 10-300
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6717
Practice Address - Country:US
Practice Address - Phone:707-784-2150
Practice Address - Fax:707-784-2103
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS137151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical