Provider Demographics
NPI:1114042090
Name:NORVAIS, ROXANA M (MA,LCPC)
Entity Type:Individual
Prefix:MS
First Name:ROXANA
Middle Name:M
Last Name:NORVAIS
Suffix:
Gender:F
Credentials:MA,LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16401 65TH CT
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1810
Mailing Address - Country:US
Mailing Address - Phone:708-614-7359
Mailing Address - Fax:708-532-6449
Practice Address - Street 1:16860 OAK PARK AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2761
Practice Address - Country:US
Practice Address - Phone:708-614-7359
Practice Address - Fax:708-532-6449
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001633570OtherBLUE CROSS BLUE SHIELD