Basic Information
| Provider Information | |||||||||
| NPI: | 1477656098 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BASH | ||||||||
| FirstName: | ROGER | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10070 DAPHNE AVE | ||||||||
| Address2: | |||||||||
| City: | PALM BEACH GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616221678 | ||||||||
| FaxNumber: | 5617995902 | ||||||||
| Practice Location | |||||||||
| Address1: | 10301 HAGEN RANCH RD STE B6 | ||||||||
| Address2: | |||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334373723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617529490 | ||||||||
| FaxNumber: | 5617529491 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 01/07/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | PY4544 | FL | N | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103T00000X | PY4544 | FL | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.