Provider Demographics
NPI:1154885887
Name:ROGERS, ROBERT
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:ROGERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 MURDOCK RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-1824
Mailing Address - Country:US
Mailing Address - Phone:407-721-5947
Mailing Address - Fax:
Practice Address - Street 1:314 WYNDHURST AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2416
Practice Address - Country:US
Practice Address - Phone:443-681-9935
Practice Address - Fax:443-687-8662
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9063101Y00000X
MDLC10874101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor