Provider Demographics
NPI:1447485859
Name:RHOME-BOROFF, AVIANCE ALEATA (PSYD)
Entity type:Individual
Prefix:
First Name:AVIANCE
Middle Name:ALEATA
Last Name:RHOME-BOROFF
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:AVIANCE
Other - Middle Name:ALEATA
Other - Last Name:RHOME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 NEVIN AVE DEPT OF
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-3143
Mailing Address - Country:US
Mailing Address - Phone:510-307-1669
Mailing Address - Fax:
Practice Address - Street 1:901 NEVIN AVE DEPT OF
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-3143
Practice Address - Country:US
Practice Address - Phone:510-307-1669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YP2500X, 101YS0200X, 106H00000X, 251S00000X
CA28931103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No251S00000XAgenciesCommunity/Behavioral Health