Provider Demographics
NPI:1396749230
Name:HALCZAK, ROXANNE (LCSW/MSW)
Entity type:Individual
Prefix:MS
First Name:ROXANNE
Middle Name:
Last Name:HALCZAK
Suffix:
Gender:F
Credentials:LCSW/MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 3RD ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-0714
Mailing Address - Country:US
Mailing Address - Phone:707-268-2800
Mailing Address - Fax:707-445-7547
Practice Address - Street 1:1711 3RD ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-0714
Practice Address - Country:US
Practice Address - Phone:707-268-2800
Practice Address - Fax:707-445-7547
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 20799101Y00000X
CA207991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor