Provider Demographics
NPI:1760949770
Name:ANDERSON, ROXANNA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROXANNA
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22198 BELLA LAGO DR APT 1113
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-4838
Mailing Address - Country:US
Mailing Address - Phone:561-577-3186
Mailing Address - Fax:954-530-1034
Practice Address - Street 1:450 NE 44TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-1423
Practice Address - Country:US
Practice Address - Phone:954-462-4599
Practice Address - Fax:954-530-1034
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health