Provider Demographics
NPI:1982888418
Name:KUNZ, ROXANE BROWN (MA)
Entity type:Individual
Prefix:MS
First Name:ROXANE
Middle Name:BROWN
Last Name:KUNZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:ROXANE
Other - Middle Name:BROWN
Other - Last Name:KUNZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:22610 N LAS BRIZAS LANE
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:81535-2829
Mailing Address - Country:US
Mailing Address - Phone:623-214-6950
Mailing Address - Fax:
Practice Address - Street 1:22610 N LAS BRIZAS LN
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-2829
Practice Address - Country:US
Practice Address - Phone:623-214-6950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X103TS0200X
AZ10103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ55472OtherACHHS NUMBER
AZ1982888418OtherACHHS