Provider Demographics
NPI:1659851186
Name:MCCABE, ROXANNA
Entity type:Individual
Prefix:
First Name:ROXANNA
Middle Name:
Last Name:MCCABE
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 1:6305 RITA AVENUE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255
Mailing Address - Country:US
Mailing Address - Phone:323-205-5679
Mailing Address - Fax:
Practice Address - Street 1:6305 RITA AVENUE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255
Practice Address - Country:US
Practice Address - Phone:323-205-5679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2024-12-20
Deactivation Date:2021-03-11
Deactivation Code:
Reactivation Date:2024-12-20
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA131548106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program