Provider Demographics
NPI:1164110268
Name:ROXBOROUGH, DANIELLE ELYSE (AMFT)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:ELYSE
Last Name:ROXBOROUGH
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 1:2703 VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-3950
Mailing Address - Country:US
Mailing Address - Phone:818-481-6229
Mailing Address - Fax:
Practice Address - Street 1:909 ELECTRIC AVE STE 308
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-8903
Practice Address - Country:US
Practice Address - Phone:714-797-5445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112972106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist