Provider Demographics
NPI:1316568868
Name:CLEVER, ROXANNE (LMSW)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:CLEVER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 W ROSSER ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1275
Mailing Address - Country:US
Mailing Address - Phone:928-277-6770
Mailing Address - Fax:
Practice Address - Street 1:475 W ROSSER ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1275
Practice Address - Country:US
Practice Address - Phone:928-277-6770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17133104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty