Provider Demographics
NPI:1922416049
Name:ROKACH-SHAMAY, MICHAL
Entity Type:Individual
Prefix:
First Name:MICHAL
Middle Name:
Last Name:ROKACH-SHAMAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2341
Mailing Address - Country:US
Mailing Address - Phone:510-333-5058
Mailing Address - Fax:
Practice Address - Street 1:1051 SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2341
Practice Address - Country:US
Practice Address - Phone:510-333-5058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-01
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR-DMT-1937225600000X
CAIMF74644101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist