Provider Demographics
NPI:1245332071
Name:ROELKE, DEBRA THOMASON (PHD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:THOMASON
Last Name:ROELKE
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 1:150 LINDEN DR
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-1965
Mailing Address - Country:US
Mailing Address - Phone:973-644-0033
Mailing Address - Fax:
Practice Address - Street 1:50 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-5296
Practice Address - Country:US
Practice Address - Phone:973-644-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00387000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ046392Medicare ID - Type Unspecified