Provider Demographics
NPI:1316096209
Name:ROGERS, GINA MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:MARIE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 E LAKESIDE DR UNIT 26
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-8013
Mailing Address - Country:US
Mailing Address - Phone:480-497-9790
Mailing Address - Fax:
Practice Address - Street 1:500 E HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-3427
Practice Address - Country:US
Practice Address - Phone:480-497-9790
Practice Address - Fax:480-813-1669
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSW-1070611041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool