Provider Demographics
NPI:1235160425
Name:ROWE, ROGER DALE (MSW)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:DALE
Last Name:ROWE
Suffix:
Gender:M
Credentials:MSW
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 15282
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-1282
Mailing Address - Country:US
Mailing Address - Phone:941-746-4645
Mailing Address - Fax:
Practice Address - Street 1:109 44TH AVE E
Practice Address - Street 2:SUITE 317
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-3640
Practice Address - Country:US
Practice Address - Phone:941-746-4645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 16721041C0700X
FLMT 1768106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ4392Medicare ID - Type UnspecifiedBLUECROSS BLUESHIELD