1548286271 NPI number — MS. CAROLYN ANN ROGERS L.C.S.W.

Table of content: MS. CAROLYN ANN ROGERS L.C.S.W. (NPI 1548286271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548286271 NPI number — MS. CAROLYN ANN ROGERS L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROGERS
Provider First Name:
CAROLYN
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KNERR
Provider Other First Name:
CAROLYN
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548286271
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2450 PERALTA BLVD
Provider Second Line Business Mailing Address:
SUITE 212
Provider Business Mailing Address City Name:
FREMONT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94536-3827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-792-6906
Provider Business Mailing Address Fax Number:
510-652-7299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2450 PERALTA BLVD
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
FREMONT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94536-3827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-792-6906
Provider Business Practice Location Address Fax Number:
510-652-7299
Provider Enumeration Date:
07/14/2006

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: 1041C0700X , with the licence number:  LCS 5603 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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