Provider Demographics
NPI:1366722688
Name:ROFFMAN, ROGER ALAN (DSW)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:ALAN
Last Name:ROFFMAN
Suffix:
Gender:M
Credentials:DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95936
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-2936
Mailing Address - Country:US
Mailing Address - Phone:206-915-6544
Mailing Address - Fax:206-685-8739
Practice Address - Street 1:909 NE 43RD ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-6020
Practice Address - Country:US
Practice Address - Phone:206-915-6544
Practice Address - Fax:206-685-8937
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000049841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical