Provider Demographics
NPI:1962062307
Name:ROGERS, WILLIAM BOWDITCH JR (MA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BOWDITCH
Last Name:ROGERS
Suffix:JR
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3468 MT DIABLO BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3957
Mailing Address - Country:US
Mailing Address - Phone:510-517-3284
Mailing Address - Fax:
Practice Address - Street 1:3468 MT DIABLO BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3957
Practice Address - Country:US
Practice Address - Phone:510-517-3284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA143690106H00000X
CA117540106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist