Provider Demographics
NPI:1952545501
Name:MYERS, ROXANNE FRANCINE (ME, PHD)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:FRANCINE
Last Name:MYERS
Suffix:
Gender:F
Credentials:ME, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6613 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19126-3123
Mailing Address - Country:US
Mailing Address - Phone:215-276-1188
Mailing Address - Fax:
Practice Address - Street 1:6613 N 4TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19126-3123
Practice Address - Country:US
Practice Address - Phone:215-276-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251S00000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health