Provider Demographics
NPI:1972527273
Name:ROGERS, DAVID LENOIR (LCSW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LENOIR
Last Name:ROGERS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 ANGELL CT
Mailing Address - Street 2:APT 102
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-7148
Mailing Address - Country:US
Mailing Address - Phone:650-799-8665
Mailing Address - Fax:
Practice Address - Street 1:795 WILLOW RD
Practice Address - Street 2:BLDG 351
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-2539
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:650-617-2686
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 00037111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1041C0700XOtherCLINICAL SOCIAL WORKER