Healthcare Provider Details

I. General information

NPI: 1972556736
Provider Name (Legal Business Name): DEBORAH D ROLLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W SHELBY ST
FALMOUTH KY
41040-1140
US

IV. Provider business mailing address

503 WATSON RD
ERLANGER KY
41018-1556
US

V. Phone/Fax

Practice location:
  • Phone: 859-654-6327
  • Fax:
Mailing address:
  • Phone: 859-835-2573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberKY-1699
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: