Provider Demographics
NPI:1033887005
Name:ROGGENBUCK, ROBERT M
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:ROGGENBUCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7246 HIGHLAND LOOP
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-4261
Mailing Address - Country:US
Mailing Address - Phone:734-292-5867
Mailing Address - Fax:
Practice Address - Street 1:7246 HIGHLAND LOOP
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-4261
Practice Address - Country:US
Practice Address - Phone:734-292-5867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2101694-TRNE104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker