Provider Demographics
NPI:1518307867
Name:ROEBACK CONSULTING
Entity Type:Organization
Organization Name:ROEBACK CONSULTING
Other - Org Name:QUALITY FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHIRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROEBACK
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:347-693-1351
Mailing Address - Street 1:593 VANDERBILT AVE
Mailing Address - Street 2:132#
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-3512
Mailing Address - Country:US
Mailing Address - Phone:347-693-1351
Mailing Address - Fax:347-365-4350
Practice Address - Street 1:593 VANDERBILT AVE
Practice Address - Street 2:132#
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-3512
Practice Address - Country:US
Practice Address - Phone:347-693-1351
Practice Address - Fax:347-365-4350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072489-1251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health