Provider Demographics
NPI:1154599595
Name:PATRICIA R. ROGERS, LICSW,PC
Entity type:Organization
Organization Name:PATRICIA R. ROGERS, LICSW,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:781-769-6834
Mailing Address - Street 1:1 WALPOLE ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3315
Mailing Address - Country:US
Mailing Address - Phone:781-769-6834
Mailing Address - Fax:781-769-7008
Practice Address - Street 1:1 WALPOLE ST
Practice Address - Street 2:SUITE 7
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3315
Practice Address - Country:US
Practice Address - Phone:781-769-6834
Practice Address - Fax:781-769-7008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106353251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP10211OtherBLUE CROSS OF MA
MAROP22227Medicare UPIN