Provider Demographics
NPI:1386113058
Name:MAURER-ROGERS, MAE (LADC LICSW)
Entity type:Individual
Prefix:
First Name:MAE
Middle Name:
Last Name:MAURER-ROGERS
Suffix:
Gender:F
Credentials:LADC LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355-2208
Mailing Address - Country:US
Mailing Address - Phone:320-296-1121
Mailing Address - Fax:
Practice Address - Street 1:109 WASHBURNE AVE
Practice Address - Street 2:
Practice Address - City:PAYNESVILLE
Practice Address - State:MN
Practice Address - Zip Code:56362-1640
Practice Address - Country:US
Practice Address - Phone:320-296-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-24
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN180471041C0700X
MN304336101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical