Provider Demographics
NPI:1730299751
Name:ROOTH-FOGEL, ROBIN JANEL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:JANEL
Last Name:ROOTH-FOGEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0148421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA052661H2CMedicare Oscar/Certification