1881105369 NPI number — MS. SHERLENA ELIZABETH ROACH CERT. SOCIAL WORKER

Table of content: MS. SHERLENA ELIZABETH ROACH CERT. SOCIAL WORKER (NPI 1881105369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881105369 NPI number — MS. SHERLENA ELIZABETH ROACH CERT. SOCIAL WORKER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROACH
Provider First Name:
SHERLENA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CERT. SOCIAL WORKER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROACH
Provider Other First Name:
SHERLENA
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1881105369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2736 A P TUREAUD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70119-1126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-701-9181
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1104 4TH ST STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRETNA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70053-5909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-262-8884
Provider Business Practice Location Address Fax Number:
504-309-9066
Provider Enumeration Date:
10/23/2017

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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