Provider Demographics
NPI:1215523410
Name:ROGERS, CYNTHIA B (MA, LMFT, RDT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:B
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MA, LMFT, RDT
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:ROGERS
Other - Last Name:BAGGOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19458 REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MONTE RIO
Mailing Address - State:CA
Mailing Address - Zip Code:95462-9759
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 BERGEN ALY
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-1219
Practice Address - Country:US
Practice Address - Phone:415-225-5725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-12
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT36878106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist