Provider Demographics
NPI:1093009581
Name:ROEHM, STEPHEN M (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:ROEHM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9619 HIGHWAY 1078 N
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-9793
Mailing Address - Country:US
Mailing Address - Phone:812-550-5154
Mailing Address - Fax:
Practice Address - Street 1:9619 HIGHWAY 1078 N
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-9793
Practice Address - Country:US
Practice Address - Phone:812-550-5154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical