MEDICARE: MS. ROXANNE KELBER LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	113585	MA

General Provider Information

NPI Number	:	1497140289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROXANNE KELBER LICSW

Provider Business Mailing Address
First Line	:	PO BOX 2
Second Line	:
City	:	SHARON
State	:	MA
Zip	:	02067-0002
Country	:	US
Telephone Number	:	339-364-8510
Fax Number	:	781-562-1928

Provider Business Practice Location Address
First Line	:	1032 TURNPIKE ST
Second Line	:	SUITE 204
City	:	CANTON
State	:	MA
Zip	:	02021-2865
Country	:	US
Telephone Number	:	339-364-8510
Fax Number	:	781-562-1928

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2015
Last Update Date	:	03/30/2015

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