1255413068 NPI number — MS. PATRICIA A. ROGERS LCSW

Table of content: MS. PATRICIA A. ROGERS LCSW (NPI 1255413068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255413068 NPI number — MS. PATRICIA A. ROGERS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROGERS
Provider First Name:
PATRICIA
Provider Middle Name:
A.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

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:
1255413068
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 CANTERBURY CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTONVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10992-1134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-304-7913
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 N MAIN ST
Provider Second Line Business Practice Location Address:
STE 207
Provider Business Practice Location Address City Name:
NEW CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10956-3743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-304-7913
Provider Business Practice Location Address Fax Number:
845-638-5971
Provider Enumeration Date:
10/20/2006

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:  R057702-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02635638 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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