Provider Demographics
NPI:1295073666
Name:ROBARGE, ALAN (MA)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:ROBARGE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 WALNUT ST APT 302
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5439
Mailing Address - Country:US
Mailing Address - Phone:215-983-9407
Mailing Address - Fax:
Practice Address - Street 1:1218 WALNUT ST APT 302
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5439
Practice Address - Country:US
Practice Address - Phone:215-983-9407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-19
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006815101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional