Provider Demographics
NPI:1194334060
Name:ROGERS, JODI N (LMHC)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:N
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 DELAWARE TPKE
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-5520
Mailing Address - Country:US
Mailing Address - Phone:518-253-6771
Mailing Address - Fax:
Practice Address - Street 1:1241 DELAWARE TPKE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-5520
Practice Address - Country:US
Practice Address - Phone:518-253-6771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY011528101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health