Provider Demographics
NPI:1043903321
Name:ROOF, JANICE L
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:L
Last Name:ROOF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2174 CHALKLEVEL RD
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:VA
Mailing Address - Zip Code:23093-5301
Mailing Address - Country:US
Mailing Address - Phone:540-634-0349
Mailing Address - Fax:
Practice Address - Street 1:2174 CHALKLEVEL RD
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:VA
Practice Address - Zip Code:23093-5301
Practice Address - Country:US
Practice Address - Phone:154-063-4034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician