1013576305 NPI number — MRS. DANIELLE M STEVENS ROANE LCSW

Table of content: MRS. DANIELLE M STEVENS ROANE LCSW (NPI 1013576305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013576305 NPI number — MRS. DANIELLE M STEVENS ROANE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEVENS ROANE
Provider First Name:
DANIELLE
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEVENS
Provider Other First Name:
DANIELLE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1013576305
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1909 SCOTT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COPPERAS COVE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76522-7776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-798-4473
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
326 MORGAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARKER HEIGHTS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76548-3077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-953-7614
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  61655 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com