MEDICARE: SINAMI ROSHAMA MAXIE MS, 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	116838	CA
2	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	116838	OTHER	CA	CALIFORNIA BOARD OF BEHAVIORAL SCIENCES

General Provider Information

NPI Number	:	1487718821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SINAMI ROSHAMA MAXIE MS, LMFT

Provider Business Mailing Address
First Line	:	825 WEBSTER ST STE F
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-5522
Country	:	US
Telephone Number	:	707-673-2133
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 WEBSTER ST STE F
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-5522
Country	:	US
Telephone Number	:	707-673-2133
Fax Number	:

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	10/19/2021

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