DIANE M MOGA-ROACH MSE LCSW LPC CEAP NPI 1700923471

NPI Information

NPI: 1700923471
Provider Name: DIANE M MOGA-ROACH, MSE, LCSW, LPC, CEAP
Classification: Counselor - 101YP2500X
Entity Type: Individual

Specialization: Professional

PECOS Registration: Yes

Address:
2733 S RIDGE RD
GREEN BAY, WI
ZIP 54304
Phone: (920) 497-6200
Get Directions

Diane M Moga-roach, MSE, LCSW, LPC, CEAP is a professional counselor in Green Bay, WI with 29 years of experience. Diane M Moga-roach, MSE, LCSW, LPC, CEAP NPI is 1700923471. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2733 S RIDGE RD
GREEN BAY, WI
ZIP 54304-513
Phone: (920) 497-6200
Fax: (920) 497-3135

The NPI 1700923471 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 1/31/2007 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YP2500X	Counselor	Professional	1849-125	WISCONSIN	Yes
2	1041C0700X	Social Worker	Clinical	3562-123	WISCONSIN	X

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	39742500	MEDICAID	WISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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