Individual
ALEC DANIEL ROA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
77 WARREN ST BLDG 5, BRIGHTON, MA 02135-3601
(617) 254-1271
Mailing address
77 WARREN ST BLDG 5, BRIGHTON, MA 02135-3601
(617) 254-1271
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08745596
KAISER
CA
Enumeration date
06/22/2019
Last updated
09/20/2024
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