Provider Demographics
NPI:1366596249
Name:ROGGE, JOEL J (EDD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:J
Last Name:ROGGE
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-2356
Mailing Address - Country:US
Mailing Address - Phone:978-356-7040
Mailing Address - Fax:978-356-3678
Practice Address - Street 1:84 COUNTY RD
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938-2356
Practice Address - Country:US
Practice Address - Phone:978-356-7040
Practice Address - Fax:978-356-3678
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1878103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW02030OtherBLUE CROSS