Healthcare Provider Details

I. General information

NPI: 1619789807
Provider Name (Legal Business Name): ROXANN HART
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 ENCINAL ST STE 200
SANTA CRUZ CA
95060-2178
US

IV. Provider business mailing address

380 ENCINAL ST STE 200
SANTA CRUZ CA
95060-2178
US

V. Phone/Fax

Practice location:
  • Phone: 831-469-1700
  • Fax: 831-425-1905
Mailing address:
  • Phone: 831-469-1700
  • Fax: 831-425-1905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: