Provider Demographics
NPI:1205936622
Name:NORVELL, ROXANNE (PHD)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:NORVELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ROXANNE
Other - Middle Name:
Other - Last Name:ROBBINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8833 E SHELBY DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125
Mailing Address - Country:US
Mailing Address - Phone:901-550-5376
Mailing Address - Fax:901-763-4060
Practice Address - Street 1:8833 E SHELBY DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125
Practice Address - Country:US
Practice Address - Phone:901-550-5376
Practice Address - Fax:901-763-4060
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP925103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3680812Medicare ID - Type Unspecified