Provider Demographics
NPI:1720219280
Name:ROJO, MATTHEW (MFT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:ROJO
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 1:3956 EDGEMOOR PL
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2606
Mailing Address - Country:US
Mailing Address - Phone:415-820-1487
Mailing Address - Fax:510-878-7369
Practice Address - Street 1:1535 N MAIN ST STE 250
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4606
Practice Address - Country:US
Practice Address - Phone:925-315-8205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46949106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist