Provider Demographics
NPI:1699929158
Name:ROGERS, JOHN JOSEPH JR (MA, MFTI)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:ROGERS
Suffix:JR
Gender:M
Credentials:MA, MFTI
Other - Prefix:
Other - First Name:JJ
Other - Middle Name:
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17345 MARLIN PL
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4422
Mailing Address - Country:US
Mailing Address - Phone:818-522-9332
Mailing Address - Fax:
Practice Address - Street 1:5445 BALBOA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1509
Practice Address - Country:US
Practice Address - Phone:818-386-5690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 53848106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist