Provider Demographics
NPI:1841272960
Name:ROFFEY, STEPHANIE LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:ROFFEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LYNN
Other - Last Name:RUSKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:18701 THE COMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-7070
Mailing Address - Country:US
Mailing Address - Phone:704-516-0971
Mailing Address - Fax:
Practice Address - Street 1:19501 W CATAWBA AVE
Practice Address - Street 2:SUITE 15 MAILBOX 22
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-4017
Practice Address - Country:US
Practice Address - Phone:704-516-0971
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC003522104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002502Medicaid