Provider Demographics
NPI:1063715506
Name:ROE & ASSOCIATES INTEGRATED BEHAVIOR SUPPORTS, INC.
Entity type:Organization
Organization Name:ROE & ASSOCIATES INTEGRATED BEHAVIOR SUPPORTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SELENA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:727-327-2457
Mailing Address - Street 1:300 31ST ST N STE 230
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-7623
Mailing Address - Country:US
Mailing Address - Phone:727-327-2457
Mailing Address - Fax:727-322-9839
Practice Address - Street 1:300 31ST ST N STE 230
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-7623
Practice Address - Country:US
Practice Address - Phone:727-327-2457
Practice Address - Fax:727-322-9839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL678552296OtherMEDICAID WAIVER
FL678552298OtherMEDICAID WAIVER