Provider Demographics
NPI:1497456065
Name:KING, ROGSBERT FRENZELL (LADC)
Entity Type:Individual
Prefix:
First Name:ROGSBERT
Middle Name:FRENZELL
Last Name:KING
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:ROGSBERT
Other - Middle Name:FRENZELL
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LADC
Mailing Address - Street 1:45 BANK ST APT 4
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-2099
Mailing Address - Country:US
Mailing Address - Phone:203-923-6474
Mailing Address - Fax:
Practice Address - Street 1:45 BANK ST APT 4
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-2099
Practice Address - Country:US
Practice Address - Phone:203-923-6474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001479101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)