Provider Demographics
NPI:1164773032
Name:ROESSER, KEREN MARIE (LMHC, CAP, SAP, CRC)
Entity Type:Individual
Prefix:
First Name:KEREN
Middle Name:MARIE
Last Name:ROESSER
Suffix:
Gender:F
Credentials:LMHC, CAP, SAP, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 POINSETTIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407
Mailing Address - Country:US
Mailing Address - Phone:561-398-8336
Mailing Address - Fax:
Practice Address - Street 1:2809 POINSETTIA AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407
Practice Address - Country:US
Practice Address - Phone:561-469-9934
Practice Address - Fax:561-469-9934
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FLMH11184101YA0400X
NCC982567101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)