Provider Demographics
NPI:1659518900
Name:GERMAIN, ROULA (MA)
Entity Type:Individual
Prefix:MS
First Name:ROULA
Middle Name:
Last Name:GERMAIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 N WESTRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-2074
Mailing Address - Country:US
Mailing Address - Phone:949-294-9614
Mailing Address - Fax:
Practice Address - Street 1:16332 N PACIFIC AVE UNIT A
Practice Address - Street 2:
Practice Address - City:SUNSET BEACH
Practice Address - State:CA
Practice Address - Zip Code:90742-2058
Practice Address - Country:US
Practice Address - Phone:949-294-9614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT47565106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist