Provider Demographics
NPI:1356429328
Name:CROFT, ROXANNE G X (PHD)
Entity type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:G
Last Name:CROFT
Suffix:X
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 1:114 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2164
Mailing Address - Country:US
Mailing Address - Phone:732-828-5694
Mailing Address - Fax:
Practice Address - Street 1:114 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2164
Practice Address - Country:US
Practice Address - Phone:732-828-5694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00154500103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical