Provider Demographics
NPI:1275299984
Name:BADGER, ROOSEVELT JR
Entity Type:Individual
Prefix:
First Name:ROOSEVELT
Middle Name:
Last Name:BADGER
Suffix:JR
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 1:10200 N ARMENIA AVE APT 3104
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7362
Mailing Address - Country:US
Mailing Address - Phone:305-748-3905
Mailing Address - Fax:
Practice Address - Street 1:10200 N ARMENIA AVE APT 3104
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7362
Practice Address - Country:US
Practice Address - Phone:305-748-3905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical