Healthcare Provider Details

I. General information

NPI: 1689086621
Provider Name (Legal Business Name): ROANNE JOY TIONGSON VELARDE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROANNE JOY TIONGSON

II. Dates (important events)

Enumeration Date: 05/26/2014
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 N OAKLAND AVE
PASADENA CA
91101-1714
US

IV. Provider business mailing address

180 N OAKLAND AVE
PASADENA CA
91101-1714
US

V. Phone/Fax

Practice location:
  • Phone: 626-584-5555
  • Fax:
Mailing address:
  • Phone: 626-584-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY0954
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number31744
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number203308
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: