Provider Demographics
NPI:1114041738
Name:ROEBKE, REBECCA
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:ROEBKE
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 1:260 CHAPMAN RD
Mailing Address - Street 2:SUITE 100 H
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5490
Mailing Address - Country:US
Mailing Address - Phone:302-292-1334
Mailing Address - Fax:302-292-1349
Practice Address - Street 1:260 CHAPMAN RD
Practice Address - Street 2:SUITE 100 H
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5490
Practice Address - Country:US
Practice Address - Phone:302-292-1334
Practice Address - Fax:302-292-1349
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
DEQ1-00010131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health