Provider Demographics
NPI:1699769570
Name:ROGAK, JENNIFER LAURA (LCSW R)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LAURA
Last Name:ROGAK
Suffix:
Gender:F
Credentials:LCSW R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 WESTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2837
Mailing Address - Country:US
Mailing Address - Phone:516-313-5556
Mailing Address - Fax:631-751-5762
Practice Address - Street 1:8 WESTWOOD AVE
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2837
Practice Address - Country:US
Practice Address - Phone:516-313-5556
Practice Address - Fax:631-751-5762
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR052561-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02561360Medicaid
NY02561360Medicaid
N534L1Medicare ID - Type Unspecified