Provider Demographics
NPI:1649603457
Name:RAFIEPOUR, ROXANNE JULIA (MA)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:JULIA
Last Name:RAFIEPOUR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1991 CALIFORNIA ST APT 301
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4411
Mailing Address - Country:US
Mailing Address - Phone:626-840-4084
Mailing Address - Fax:
Practice Address - Street 1:1701 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-1727
Practice Address - Country:US
Practice Address - Phone:415-452-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6CDC367101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health