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General NPI Number Information
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NPI Number | 1134475452
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Entity Type | Individual
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Provider Name | MICHAEL ROE LCSW, LCPC
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Gender | Male
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Dates
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Enumeration Date | 07/24/2012
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Last Update Date | 04/30/2016
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Provider Practice Location Address
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Address Line | 1200 RING RD 2454
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City | CALUMET CITY
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State | IL
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Zip | 60409-7200
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Country | US
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Telephone | 708-898-8745
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 RING RD 2454
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City | CALUMET CITY
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State | IL
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Zip | 60409-7200
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Country | US
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Telephone | 708-898-8745
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.016500
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.007091
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License Number State | IL
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