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General NPI Number Information
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NPI Number | 1407574163
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Entity Type | Individual
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Provider Name | MS. ELIZABETH ROGGEVEEN
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Gender | Female
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Dates
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Enumeration Date | 08/18/2022
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 2235 MERCURY WAY
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City | SANTA ROSA
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State | CA
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Zip | 95407-5473
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Country | US
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Telephone | 415-457-6964
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Fax |
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Provider Business Mailing Address
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Address Line | 201 ALAMEDA DEL PRADO
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City | NOVATO
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State | CA
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Zip | 94949-6688
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Country | US
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Telephone | 415-457-6964
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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