Provider Demographics
NPI:1750044137
Name:MANFREDI-GIAMMONA, ROXANNA (LICENSED CLINICAL PS)
Entity Type:Individual
Prefix:
First Name:ROXANNA
Middle Name:
Last Name:MANFREDI-GIAMMONA
Suffix:
Gender:F
Credentials:LICENSED CLINICAL PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 N. CALIFORNIA BLVD.
Mailing Address - Street 2:SUITE 800
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596
Mailing Address - Country:US
Mailing Address - Phone:925-239-0338
Mailing Address - Fax:
Practice Address - Street 1:1990 N. CALIFORNIA BLVD.
Practice Address - Street 2:SUITE 800
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596
Practice Address - Country:US
Practice Address - Phone:925-239-0338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24816103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist