Provider Demographics
NPI:1851282214
Name:ROE, MIRIAM
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:
Last Name:ROE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 N.CENTRAL, WOODMERE,NY 11598
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2104
Mailing Address - Country:US
Mailing Address - Phone:519-206-8900
Mailing Address - Fax:
Practice Address - Street 1:11476 S APOPKA VINELAND RD STE 118
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-7006
Practice Address - Country:US
Practice Address - Phone:407-955-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician