Provider Demographics
NPI:1740432376
Name:ROSKELLEY, CRISTY WALKER (MFT)
Entity Type:Individual
Prefix:
First Name:CRISTY
Middle Name:WALKER
Last Name:ROSKELLEY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 BON AIR RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1752
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 BON AIR RD
Practice Address - Street 2:SUITE 140
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1752
Practice Address - Country:US
Practice Address - Phone:415-289-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45504106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist