Provider Demographics
NPI:1346528668
Name:ROGER, ANNA KATHRYN (LCSW)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:KATHRYN
Last Name:ROGER
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:PO BOX 371539
Mailing Address - Street 2:
Mailing Address - City:MONTARA
Mailing Address - State:CA
Mailing Address - Zip Code:94037-1539
Mailing Address - Country:US
Mailing Address - Phone:781-608-9520
Mailing Address - Fax:
Practice Address - Street 1:1132 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:MONTARA
Practice Address - State:CA
Practice Address - Zip Code:94037-9898
Practice Address - Country:US
Practice Address - Phone:816-089-5207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA640011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical