Healthcare Provider Details

I. General information

NPI: 1124631791
Provider Name (Legal Business Name): ROXANNA LLAMAS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date: 06/17/2021
Reactivation Date: 07/12/2021

III. Provider practice location address

1330 BEACON ST STE 209
BROOKLINE MA
02446-3202
US

IV. Provider business mailing address

655 CENTRE ST UNIT 300115
JAMAICA PLAIN MA
02130-6404
US

V. Phone/Fax

Practice location:
  • Phone: 617-369-7477
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10001657
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: