Provider Demographics
NPI:1174829170
Name:REID, ROXROY ANTHONY (LISW)
Entity type:Individual
Prefix:MR
First Name:ROXROY
Middle Name:ANTHONY
Last Name:REID
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CAMINO COLLADO
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-9788
Mailing Address - Country:US
Mailing Address - Phone:505-710-4278
Mailing Address - Fax:505-286-0865
Practice Address - Street 1:25 CAMINO COLLADO
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015-9788
Practice Address - Country:US
Practice Address - Phone:505-710-4278
Practice Address - Fax:505-286-0865
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical