Provider Demographics
NPI:1043371768
Name:KALCH, ROXANNE V (LCSW, LAC)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:V
Last Name:KALCH
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:ROXANNE
Other - Middle Name:V
Other - Last Name:FELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6360 TECHSTER BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-4805
Mailing Address - Country:US
Mailing Address - Phone:239-223-2751
Mailing Address - Fax:
Practice Address - Street 1:2721 DEL PRADO BLVD S STE 200
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904
Practice Address - Country:US
Practice Address - Phone:239-673-9034
Practice Address - Fax:239-673-9102
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86000172A101YA0400X
IN33005112A104100000X
IN34006093A1041C0700X
FLSW163461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000392863OtherANTHEM
IN600018-064OtherMAGELLAN
IN200479690OtherMEDICAID SED WAIVER