Provider Demographics
NPI:1417088717
Name:ROGERS, JOSEPH PHILIP (PHD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PHILIP
Last Name:ROGERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-211 PALI MOMI ST
Mailing Address - Street 2:SUITE 707
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4301
Mailing Address - Country:US
Mailing Address - Phone:808-483-8802
Mailing Address - Fax:808-483-8802
Practice Address - Street 1:98-211 PALI MOMI ST
Practice Address - Street 2:SUITE 707
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4301
Practice Address - Country:US
Practice Address - Phone:808-483-8802
Practice Address - Fax:808-483-8802
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-357103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIA-29031OtherHMSA (PRIVATE HEALTH INS)