Provider Demographics
NPI:1174235576
Name:ROACH, DEBRA RENEE (RCMNC, BSW)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:RENEE
Last Name:ROACH
Suffix:
Gender:F
Credentials:RCMNC, BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4522 SEAGULL DR APT 801
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-2087
Mailing Address - Country:US
Mailing Address - Phone:727-601-4814
Mailing Address - Fax:
Practice Address - Street 1:4522 SEAGULL DR APT 801
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-2087
Practice Address - Country:US
Practice Address - Phone:727-601-4814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health