Healthcare Provider Details

I. General information

NPI: 1770352411
Provider Name (Legal Business Name): MATTHEW NESHAMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2023
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3554 ROUND BARN BLVD
SANTA ROSA CA
95403-0929
US

IV. Provider business mailing address

PO BOX 61
SAN GERONIMO CA
94963-0061
US

V. Phone/Fax

Practice location:
  • Phone: 707-571-3778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT143103
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: