Provider Demographics
NPI:1932283777
Name:ROUBIDEAUX, NANCY LEE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LEE
Last Name:ROUBIDEAUX
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:SULLIVAN-ONE FEATHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:206 MAIN ST # 1
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:NY
Mailing Address - Zip Code:12197-1903
Mailing Address - Country:US
Mailing Address - Phone:607-547-1600
Mailing Address - Fax:607-547-1607
Practice Address - Street 1:206 MAIN ST # 1
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:NY
Practice Address - Zip Code:12197-1903
Practice Address - Country:US
Practice Address - Phone:607-547-1600
Practice Address - Fax:607-547-1607
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061291104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker