| Anthony Roach, PC-IT, SW | |
|
3900 W Brown Deer Rd, Ste 200, Brown Deer, WI 53209-1220 | |
| (414) 540-2170 | |
| (414) 540-2171 |
| Full Name | Anthony Roach |
|---|---|
| Gender | Male |
| Speciality | Counselor - Professional |
| Location | 3900 W Brown Deer Rd, Brown Deer, Wisconsin |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083968200 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 1281-226 (Wisconsin) | Primary |
| 104100000X | Social Worker | 7196-120 (Wisconsin) | Secondary |
| Entity Name | Shorehaven Behavioral Health Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1598800740 PECOS PAC ID: 0143324954 Enrollment ID: O20070404000380 |
| Mailing Address | Practice Location Address |
|---|---|
| Anthony Roach, PC-IT, SW 3900 W Brown Deer Rd, Ste 200, Brown Deer, WI 53209-1220 Ph: (414) 540-2170 | Anthony Roach, PC-IT, SW 3900 W Brown Deer Rd, Ste 200, Brown Deer, WI 53209-1220 Ph: (414) 540-2170 |
Zoe Faivre Werth, M.S. Counselor Medicare: Not Enrolled in Medicare Practice Location: 3900 W Brown Deer Rd, Suite 200, Brown Deer, WI 53209 Phone: 414-540-2170 Fax: 414-540-2171 | |
Virginia G Livingston, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 7646 N Teutonia Ave, Brown Deer, WI 53209 Phone: 414-979-2155 | |
Jenna Mohelnitzky, LCSW Counselor Medicare: Medicare Enrolled Practice Location: 3900 W Brown Deer Rd Ste 200, Brown Deer, WI 53209 Phone: 414-540-2170 | |
Je'sean Scott, Counselor Medicare: Not Enrolled in Medicare Practice Location: 5600 W Brown Deer Rd Ste 106, Brown Deer, WI 53223 Phone: 414-446-8154 | |
Anastacia Clucas, Counselor Medicare: Not Enrolled in Medicare Practice Location: 3900 W Brown Deer Rd Ste 200, Brown Deer, WI 53209 Phone: 414-540-2170 Fax: 414-540-2171 | |
Ms. Wendy Ann Diehls, APSW Counselor Medicare: Not Enrolled in Medicare Practice Location: 3900 W Brown Deer Rd, Suite 200, Brown Deer, WI 53209 Phone: 414-540-2170 Fax: 414-540-2171 | |
Ms. Kristin Ann Johnson, MS LPC Counselor Medicare: Accepting Medicare Assignments Practice Location: 3900 W Brown Deer Rd, Suite 200, Brown Deer, WI 53209 Phone: 414-540-2170 Fax: 414-540-2171 |