Provider Demographics
NPI:1972607620
Name:ROGERS, JAIME BOYINGTON (LCSW)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:BOYINGTON
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:
Other - Last Name:BOYINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:47 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:PASSADUMKEAG
Mailing Address - State:ME
Mailing Address - Zip Code:04475-3119
Mailing Address - Country:US
Mailing Address - Phone:207-290-1338
Mailing Address - Fax:
Practice Address - Street 1:47 PLEASANT STREET
Practice Address - Street 2:
Practice Address - City:PASSADUMKEAG
Practice Address - State:ME
Practice Address - Zip Code:04475-0004
Practice Address - Country:US
Practice Address - Phone:207-732-5513
Practice Address - Fax:207-794-6777
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC106901041C0700X
MELC118381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME263840099Medicaid
ME060207OtherANTHEM
ME201837OtherNGS
ME263840099Medicaid