Provider Demographics
NPI:1184199960
Name:SIMOND, ROXANNE MARIE
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:MARIE
Last Name:SIMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 BANCROFT AVE STE 125C
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2454
Mailing Address - Country:US
Mailing Address - Phone:510-860-6475
Mailing Address - Fax:
Practice Address - Street 1:7200 BANCROFT AVE STE 125C
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2454
Practice Address - Country:US
Practice Address - Phone:151-086-0647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA101YM0800X, 175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health