Provider Demographics
NPI:1508180837
Name:ALTMAN, ROGER (MFT)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:ALTMAN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 DEVITA DR
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-5855
Mailing Address - Country:US
Mailing Address - Phone:707-337-3918
Mailing Address - Fax:
Practice Address - Street 1:3003 DEVITA DR
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-5855
Practice Address - Country:US
Practice Address - Phone:707-337-3918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6870106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist