Provider Demographics
NPI:1881902146
Name:ROE, PREEYA DIANE (LCSW)
Entity type:Individual
Prefix:
First Name:PREEYA
Middle Name:DIANE
Last Name:ROE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PREEYA
Other - Middle Name:
Other - Last Name:CARLESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5062 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5110
Mailing Address - Country:US
Mailing Address - Phone:916-806-6723
Mailing Address - Fax:
Practice Address - Street 1:601 N MARKET BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1200
Practice Address - Country:US
Practice Address - Phone:916-283-8280
Practice Address - Fax:916-238-8259
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28788104100000X
CA298311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker