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Deactivated NPI 1841370590 Deactivated / Inactive NPI Male Practitioner

Robert Michael Gollenberg , MED, CRC

Counselor • Fort Wayne, IN

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Robert Gollenberg has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date October 17, 2006
NPI Deactivation Date October 22, 2018
Total Practice Duration ~12 Years of Practice (2006 – 2018)

Professional Overview & Biography Verified Profile Summary

Robert Gollenberg, MED, CRC was a registered Counselor practicing in Fort Wayne, IN. Throughout an active medical career spanning 12 years, Robert Gollenberg provided care at the practice location at 2121 LAKE AVE until profile deactivation on 2018-10-22.

Practice Location & Contact Primary Location

Practice Address

2121 Lake Ave
Room 423, Vocational Rehabilitation

Fort Wayne, IN 468055100

Telephone 2604265431
Associated Practice Facility / Clinic
🏢 Marion Vamc Facility NPI 1427016369

Specialty Benchmarks & Practice Insights

Comparative analytics for Counselor in Fort Wayne, IN

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 12.0 Yrs
State Avg: 12.3 Yrs
Regional Practice Density
61 Specialists

Practicing in Fort Wayne, IN (1327 Statewide)

Telehealth Adoption Rate
1.6% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Counselor Primary Specialty

NUCC Taxonomy Code: 101Y00000X

State License IL C35039

A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
Tammy Moehle

Registered Nurse - Oncology

NPI 1003510157
NPI 1003779331

Doctor of Pharmacy (Pharm.D.)

Dr. Ashley Fulton , PharmD

Pharmacist - Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist

NPI 1013222645

Doctor of Pharmacy (Pharm.D.)

Danielle Schultz

Registered Nurse

NPI 1013618040
NPI 1023030285

Doctor of Medicine (M.D.)

Scott Kruse

Social Worker - Clinical

NPI 1023350717

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated October 22, 2018

Record deactivated on October 22, 2018

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 2121 LAKE AVE, ROOM 423, VOCATIONAL REHABILITATION, FORT WAYNE, IN 468055100 (Tel: 2604265431)

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Updated Business Mailing Address July 08, 2007

Registered at 2121 LAKE AVE, ROOM 423, VOCATIONAL REHABILITATION, FORT WAYNE, IN 468055100 (Tel: 2604265431)

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Provider Name / Credentials Updated July 08, 2007

Recorded as ROBERT GOLLENBERG, M.ED.,CRC

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Counselor (License #C35039 in IL)

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Initial NPI Registration & Enumeration October 17, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1841370590
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: October 17, 2006
Last Update: July 08, 2007
Deactivation Date: October 22, 2018

Mailing Address

2121 Lake Ave, Room 423, Vocational Rehabilitation

Fort Wayne, IN 468055100

Phone: 2604265431

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.