Provider Demographics
NPI:1043739972
Name:BERRY, ROXANNE RENEE (CASE MGR)
Entity Type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:RENEE
Last Name:BERRY
Suffix:
Gender:F
Credentials:CASE MGR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4980 POSSUM ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-9432
Mailing Address - Country:US
Mailing Address - Phone:740-390-8101
Mailing Address - Fax:
Practice Address - Street 1:BHP 8402 BLACKJACK RD
Practice Address - Street 2:
Practice Address - City:MT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050
Practice Address - Country:US
Practice Address - Phone:740-507-0227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator