Provider Demographics
NPI:1336223122
Name:ROANE, JOAN CAMPBELL (MFT)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:CAMPBELL
Last Name:ROANE
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 1:555 NORTHGATE DR
Mailing Address - Street 2:FAMILY SERVICE AGENCY
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3680
Mailing Address - Country:US
Mailing Address - Phone:415-491-5700
Mailing Address - Fax:415-491-5750
Practice Address - Street 1:555 NORTHGATE DR
Practice Address - Street 2:FAMILY SERVICE AGENCY
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3680
Practice Address - Country:US
Practice Address - Phone:415-491-5700
Practice Address - Fax:415-491-5750
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40032101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health