Healthcare Provider Details

I. General information

NPI: 1467975896
Provider Name (Legal Business Name): ALEXANDRA ROFFEY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 BELMONT ST
BROCKTON MA
02301-5596
US

IV. Provider business mailing address

225 COUNTY RD
HANSON MA
02341-1461
US

V. Phone/Fax

Practice location:
  • Phone: 774-826-1427
  • Fax:
Mailing address:
  • Phone: 508-577-6167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number000222811
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: