Johanna P Roque

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

AMFT143522 Issued in CA

Practice address

850 E Wardlow Rd
Long Beach, CA 90807-4628

Phone

(562) 249-9093

NPI assigned

Sep 15, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702598400000",
    "number": "1962172452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 E WARDLOW RD",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908074628",
            "telephone_number": "562-249-9093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 E WARDLOW RD",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908074628",
            "telephone_number": "562-249-9093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROQUE",
        "first_name": "JOHANNA",
        "middle_name": "P",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-15",
        "last_updated": "2023-12-15",
        "certification_date": "2023-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "AMFT143522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roots Addiction and Psychiatry Medical Group, PC
• Roots Psychological Group, PC
• Roots TMS, LLC
• Roots, Inc.
• Deyanira Roque
• Ronaldo Violeta Roque, M.D.
• Shawn Edward Roque
• Rory J Friedman DPM a Podiatry Corporation
• Yesenia Desiree Rosado, SLP/CCC
• Alejandro Rosales

• Marriage & Family Therapist in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.