Provider Demographics
NPI:1063422806
Name:VOGT, RONALD LESLIE (LCSW)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:LESLIE
Last Name:VOGT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 LINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-2140
Mailing Address - Country:US
Mailing Address - Phone:727-447-2082
Mailing Address - Fax:
Practice Address - Street 1:1507 LINWOOD DR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-2140
Practice Address - Country:US
Practice Address - Phone:727-447-2082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW59891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20855Medicare ID - Type Unspecified