Individual
DR. JOHN ED ROE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D., M.A., M.A.
Contact information
Practice address
4120 CAMERON PARK DR, SUITE 301, CAMERON PARK, CA 95682-8480
(530) 676-4445
Mailing address
4120 CAMERON PARK DR, SUITE 301, CAMERON PARK, CA 95682-8480
(530) 676-4445
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY 5769
CA
106H00000X
Marriage & Family Therapist
MFT 6551
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00PL57690
PTAN, MEDICARE
CA
Enumeration date
06/04/2007
Last updated
03/09/2009
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