Provider Demographics
NPI:1265488837
Name:BROOKE, ROGER W (PHD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:W
Last Name:BROOKE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 PENN AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:WILKINSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15221-2154
Mailing Address - Country:US
Mailing Address - Phone:412-371-7330
Mailing Address - Fax:412-242-4732
Practice Address - Street 1:224 PENN AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:WILKINSBURG
Practice Address - State:PA
Practice Address - Zip Code:15221-2154
Practice Address - Country:US
Practice Address - Phone:412-371-7330
Practice Address - Fax:412-242-4732
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2008-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007832L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA118389OtherVALUEOPTIONS
PA1601598Medicaid
PA526417OtherHIGHMARK BC BS
PA680008001OtherRAILROAD MEDICARE
PAS24401Medicare UPIN
PA1601598Medicaid