Provider Demographics
NPI:1801891833
Name:NAVAB-BOUSHEHRI, ROXANA (MA)
Entity type:Individual
Prefix:MS
First Name:ROXANA
Middle Name:
Last Name:NAVAB-BOUSHEHRI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 APPERSON DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7026
Mailing Address - Country:US
Mailing Address - Phone:504-375-2755
Mailing Address - Fax:540-375-2755
Practice Address - Street 1:431 APPERSON DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7026
Practice Address - Country:US
Practice Address - Phone:504-375-2755
Practice Address - Fax:540-375-2755
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002527101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
088346OtherSENTARA
172253OtherANTHEM
VA010129770Medicaid