Provider Demographics
NPI:1467831164
Name:ROESCH, REBECCA LYNN (MSSW, LICSW, LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:ROESCH
Suffix:
Gender:F
Credentials:MSSW, LICSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1278 LAKE ARROWHEAD RD
Mailing Address - Street 2:
Mailing Address - City:LURAY
Mailing Address - State:VA
Mailing Address - Zip Code:22835-7511
Mailing Address - Country:US
Mailing Address - Phone:703-798-8005
Mailing Address - Fax:
Practice Address - Street 1:1278 LAKE ARROWHEAD RD
Practice Address - Street 2:
Practice Address - City:LURAY
Practice Address - State:VA
Practice Address - Zip Code:22835-7511
Practice Address - Country:US
Practice Address - Phone:703-798-8005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500792881041C0700X
VA09040088581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical