Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | PS016871 | PA |
Y | 103G00000X | Clinical Psychologist | PS016871 | PA |
Y | 103TC0700X | Clinical Psychologist | PS016871 | PA |
NPI | 1013037415 |
---|---|
Provider Name | Wayne Lawrence Roffer |
First Address | Lebanon, PA 17042-7529 |
Second Address | Lebanon, PA 17042-7529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 16/08/2013 |