Provider Demographics
NPI:1841320298
Name:FOGELBERG, ROBYN DUCHARME (MSW)
Entity type:Individual
Prefix:MS
First Name:ROBYN
Middle Name:DUCHARME
Last Name:FOGELBERG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 BLUEBIRD AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-8718
Mailing Address - Country:US
Mailing Address - Phone:303-530-3260
Mailing Address - Fax:
Practice Address - Street 1:2975 VALMONT RD
Practice Address - Street 2:SUITE 300
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301
Practice Address - Country:US
Practice Address - Phone:303-443-1468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9820331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO982033OtherLCSW