Provider Demographics
NPI:1942031687
Name:DECKER, ROXANNA L (LCPCC)
Entity type:Individual
Prefix:
First Name:ROXANNA
Middle Name:L
Last Name:DECKER
Suffix:
Gender:F
Credentials:LCPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE FALLS
Mailing Address - State:ME
Mailing Address - Zip Code:04254-1511
Mailing Address - Country:US
Mailing Address - Phone:207-897-9000
Mailing Address - Fax:207-520-2373
Practice Address - Street 1:96 MAIN ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE FALLS
Practice Address - State:ME
Practice Address - Zip Code:04254-1511
Practice Address - Country:US
Practice Address - Phone:207-897-9000
Practice Address - Fax:207-520-2373
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL7605101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMETPID006505Medicaid