Provider Demographics
NPI:1972196277
Name:ROFF, SLADE MAGENTA (LSW)
Entity Type:Individual
Prefix:
First Name:SLADE
Middle Name:MAGENTA
Last Name:ROFF
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LOCUST ST APT 25H
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-0118
Mailing Address - Country:US
Mailing Address - Phone:218-213-2017
Mailing Address - Fax:
Practice Address - Street 1:8080 OLD YORK RD STE 224
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1426
Practice Address - Country:US
Practice Address - Phone:267-626-2018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1364511041C0700X
PACW0230761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical