Provider Demographics
NPI:1679113575
Name:ROBIN ROOTH-FOGEL, LCSW, LLC
Entity Type:Organization
Organization Name:ROBIN ROOTH-FOGEL, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:JANEL
Authorized Official - Last Name:ROOTH-FOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:610-282-2015
Mailing Address - Street 1:202 S. THIRD STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036
Mailing Address - Country:US
Mailing Address - Phone:610-282-2015
Mailing Address - Fax:610-282-2024
Practice Address - Street 1:202 S. THIRD STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:COOPERSBURG
Practice Address - State:PA
Practice Address - Zip Code:18036
Practice Address - Country:US
Practice Address - Phone:610-282-2015
Practice Address - Fax:610-282-2024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty