Provider Demographics
NPI:1396026001
Name:ROGERS, TAYLOR J
Entity type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:J
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 SEVERN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-1740
Mailing Address - Country:US
Mailing Address - Phone:410-752-5525
Mailing Address - Fax:410-752-5531
Practice Address - Street 1:1401 SEVERN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-1740
Practice Address - Country:US
Practice Address - Phone:410-752-5525
Practice Address - Fax:410-752-5531
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17072104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker