Provider Demographics
NPI:1720570765
Name:ROGERS, ALICE ANNE (LCAT, LCSW, MT-BC)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:ANNE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LCAT, LCSW, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 RIVERFRONT CTR
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-4620
Mailing Address - Country:US
Mailing Address - Phone:518-281-8367
Mailing Address - Fax:
Practice Address - Street 1:1700 RIVERFRONT CTR
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-4620
Practice Address - Country:US
Practice Address - Phone:518-843-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113407-01104100000X
10987225A00000X
NY0987691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist