Provider Demographics
NPI:1013084490
Name:PLATTE, ROXCY (LICSW)
Entity type:Individual
Prefix:
First Name:ROXCY
Middle Name:
Last Name:PLATTE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945
Mailing Address - Country:US
Mailing Address - Phone:781-631-4678
Mailing Address - Fax:781-631-9525
Practice Address - Street 1:599 NORTH AVE
Practice Address - Street 2:DOOR 8
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880
Practice Address - Country:US
Practice Address - Phone:781-246-0900
Practice Address - Fax:781-631-9525
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2008-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10251491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA763210OtherTUFTS HEALTH PLAN
MAP07099OtherBLUE CROSS
MAP20941Medicare PIN