Provider Demographics
NPI:1699872564
Name:ROGERS, DEBRA (MA, LPAT, LPCC)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MA, LPAT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 LOS PINOS RD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-6725
Mailing Address - Country:US
Mailing Address - Phone:505-453-0098
Mailing Address - Fax:505-452-9503
Practice Address - Street 1:3214 PURDUE PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2124
Practice Address - Country:US
Practice Address - Phone:505-453-0098
Practice Address - Fax:505-452-9503
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM66642101YP2500X
NM2986101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM18236219Medicaid
NMNM202657OtherVALUE OPTIONS
NM22586OtherLOVELACE HEALTH PLAN
NM07304536OtherDOH DD WAIVER