Provider Demographics
NPI:1104344811
Name:ROGERS, ELIZABETH (PSYD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 EATON RD
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:NH
Mailing Address - Zip Code:03608-4601
Mailing Address - Country:US
Mailing Address - Phone:802-266-0966
Mailing Address - Fax:
Practice Address - Street 1:60 AUSTINE DR
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6798
Practice Address - Country:US
Practice Address - Phone:802-266-0966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048.0134261103TC0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health