MEDICARE: MR. JOHN CHARLES ROEDEL LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	35002003A	IN
2	106H00000X	Marriage & Family Therapist	46086	CA

General Provider Information

NPI Number	:	1285833962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN CHARLES ROEDEL LMFT

Provider Business Mailing Address
First Line	:	777 DAVIS ST
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-6923
Country	:	US
Telephone Number	:	513-400-5460
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 DAVIS ST
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-6923
Country	:	US
Telephone Number	:	513-400-5460
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	01/03/2022

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Directions to “ MR. JOHN CHARLES ROEDEL LMFT” Practice Location

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