Provider Demographics
NPI:1730254830
Name:ROELOFFZEN, EDMEE (MFT)
Entity type:Individual
Prefix:MS
First Name:EDMEE
Middle Name:
Last Name:ROELOFFZEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 PINE ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-3327
Mailing Address - Country:US
Mailing Address - Phone:415-721-1964
Mailing Address - Fax:
Practice Address - Street 1:369 PINE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-3327
Practice Address - Country:US
Practice Address - Phone:415-721-1964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33987101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health