Healthcare Provider Details

I. General information

NPI: 1184199960
Provider Name (Legal Business Name): ROXANNE MARIE SIMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 BANCROFT AVE STE 125C
OAKLAND CA
94605-2454
US

IV. Provider business mailing address

7200 BANCROFT AVE STE 125C
OAKLAND CA
94605-2454
US

V. Phone/Fax

Practice location:
  • Phone: 151-086-0647
  • Fax:
Mailing address:
  • Phone: 510-860-6475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: