Healthcare Provider Details

I. General information

NPI: 1689955064
Provider Name (Legal Business Name): MS. ROSLYNN JENEANE NOBLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E 15TH ST STE B
MERCED CA
95341-6217
US

IV. Provider business mailing address

PO BOX 2087
MERCED CA
95344-0087
US

V. Phone/Fax

Practice location:
  • Phone: 209-381-6800
  • Fax:
Mailing address:
  • Phone: 209-381-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number89024
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: