Healthcare Provider Details

I. General information

NPI: 1922416049
Provider Name (Legal Business Name): MICHAL ROKACH-SHAMAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 SANTA FE AVE
ALBANY CA
94706-2341
US

IV. Provider business mailing address

1051 SANTA FE AVE
ALBANY CA
94706-2341
US

V. Phone/Fax

Practice location:
  • Phone: 510-333-5058
  • Fax:
Mailing address:
  • Phone: 510-333-5058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License NumberR-DMT-1937
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMF74644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: