=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245332071
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBRA THOMASON ROELKE PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 MAPLE AVE
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07960-5296
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-644-0033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 LINDEN DR
-----------------------------------------------------
City | BASKING RIDGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07920-1965
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-644-0033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 35SI00387000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------