Provider Demographics
NPI:1720549603
Name:ROESLER, DEBRA LEE (LMFT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LEE
Last Name:ROESLER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 LAGUNA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-1562
Mailing Address - Country:US
Mailing Address - Phone:415-513-2851
Mailing Address - Fax:
Practice Address - Street 1:2515 LAGUNA VISTA DR
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-1562
Practice Address - Country:US
Practice Address - Phone:415-513-2851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT111961106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist