Provider Demographics
NPI:1881131753
Name:SELENA ROE
Entity type:Organization
Organization Name:SELENA ROE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST/ OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROE, JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:727-327-2457
Mailing Address - Street 1:2600 MARTIN LUTHER KING ST N STE 401
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-2744
Mailing Address - Country:US
Mailing Address - Phone:727-327-2457
Mailing Address - Fax:
Practice Address - Street 1:2545 NE COACHMAN RD APT 150
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1810
Practice Address - Country:US
Practice Address - Phone:727-687-9261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB268792251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health