Provider Demographics
NPI:1972783132
Name:ROGERS, SANDRA (LMFT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 E. WALNUT ST.
Mailing Address - Street 2:#117
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1878
Mailing Address - Country:US
Mailing Address - Phone:626-795-9127
Mailing Address - Fax:626-795-0979
Practice Address - Street 1:1245 E WALNUT ST
Practice Address - Street 2:#117
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1878
Practice Address - Country:US
Practice Address - Phone:626-795-9127
Practice Address - Fax:626-795-0979
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39262106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist