1265855217 NPI number — MR. JOHN GERON ROGERS LMHC

Table of content: JOAN H GERBER OT (NPI 1871833863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265855217 NPI number — MR. JOHN GERON ROGERS LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROGERS
Provider First Name:
JOHN
Provider Middle Name:
GERON
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265855217
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
506 S. HWY 27
Provider Second Line Business Mailing Address:
STE N
Provider Business Mailing Address City Name:
MINNEOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-348-8858
Provider Business Mailing Address Fax Number:
352-414-4876

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
506 S. HWY 27
Provider Second Line Business Practice Location Address:
STE N
Provider Business Practice Location Address City Name:
MINNEOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-348-8858
Provider Business Practice Location Address Fax Number:
352-414-4876
Provider Enumeration Date:
01/28/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH12251 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MH12251 . This is a "LICENSED MENTAL HEALTH CON" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 100479600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".