Provider Demographics
NPI:1417333964
Name:ROAN, KELLY (RMHCI)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:ROAN
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:CARTWRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2901 N CAROLINE DR
Mailing Address - Street 2:306
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8465
Mailing Address - Country:US
Mailing Address - Phone:561-714-8359
Mailing Address - Fax:
Practice Address - Street 1:5305 GREENWOOD AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2451
Practice Address - Country:US
Practice Address - Phone:561-577-6651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health