Healthcare Provider Details

I. General information

NPI: 1841320298
Provider Name (Legal Business Name): ROBYN DUCHARME FOGELBERG MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2975 VALMONT RD SUITE 300
BOULDER CO
80301
US

IV. Provider business mailing address

6405 BLUEBIRD AVE
LONGMONT CO
80503-8718
US

V. Phone/Fax

Practice location:
  • Phone: 303-443-1468
  • Fax:
Mailing address:
  • Phone: 303-530-3260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number982033
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier982033
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerLCSW

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: