Provider Demographics
NPI:1124046297
Name:CHERRY, ROXANNE S (PHD MFT)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:S
Last Name:CHERRY
Suffix:
Gender:F
Credentials:PHD MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29245 POMPANO WAY
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-1674
Mailing Address - Country:US
Mailing Address - Phone:949-228-2844
Mailing Address - Fax:949-497-4324
Practice Address - Street 1:27281 LAS RAMBLAS STE 200
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8303
Practice Address - Country:US
Practice Address - Phone:949-228-2844
Practice Address - Fax:949-497-4324
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22810106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist