Provider Demographics
NPI:1184196875
Name:ROGGENTIEN, BRANDY (LCSW, BICM, PPS)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:ROGGENTIEN
Suffix:
Gender:F
Credentials:LCSW, BICM, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 801164
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91380-1164
Mailing Address - Country:US
Mailing Address - Phone:661-505-5555
Mailing Address - Fax:
Practice Address - Street 1:23501 PARK SORRENTO STE 101
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1369
Practice Address - Country:US
Practice Address - Phone:661-505-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041S0200X
CA227231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool