Provider Demographics
NPI:1578631883
Name:ROSWELL, JOY STEPHANIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JOY
Middle Name:STEPHANIE
Last Name:ROSWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3724 JEFFERSON ST STE 206
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6221
Mailing Address - Country:US
Mailing Address - Phone:512-786-8639
Mailing Address - Fax:
Practice Address - Street 1:3724 JEFFERSON ST STE 206
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6221
Practice Address - Country:US
Practice Address - Phone:512-786-8639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS064501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S01LOtherBLUE CROSS BLUE SHIELD
TX063935301Medicaid
TX00S01LOtherBLUE CROSS BLUE SHIELD