Provider Demographics
NPI:1841497658
Name:RODGERS, NANCY M (LCSW, CADC)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:M
Last Name:RODGERS
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:M
Other - Last Name:FITZPATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:33 EAST NORTHHAMPTON ST.
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18701
Mailing Address - Country:US
Mailing Address - Phone:570-829-3489
Mailing Address - Fax:570-829-7781
Practice Address - Street 1:33 EAST NORTHHAMPTON ST.
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701
Practice Address - Country:US
Practice Address - Phone:570-829-3489
Practice Address - Fax:570-829-7781
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAC.A.C. 7131101YA0400X
PACW0179461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)