Provider Demographics
NPI:1356871131
Name:NOE, ROGER (CDCA)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:NOE
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 HOLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44904-1819
Mailing Address - Country:US
Mailing Address - Phone:567-241-5892
Mailing Address - Fax:
Practice Address - Street 1:652 HOLIDAY DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44904-1819
Practice Address - Country:US
Practice Address - Phone:567-241-5892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor