Provider Demographics
NPI:1407021587
Name:LORD, ROXANNE GAY
Entity Type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:GAY
Last Name:LORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 ALBATROSS WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-2878
Mailing Address - Country:US
Mailing Address - Phone:916-914-7207
Mailing Address - Fax:
Practice Address - Street 1:2445 ALBATROSS WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-2878
Practice Address - Country:US
Practice Address - Phone:916-914-7207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health