Provider Demographics
NPI:1053080234
Name:ROGERS, CLARENCE LLOYD (LMSW)
Entity Type:Individual
Prefix:
First Name:CLARENCE
Middle Name:LLOYD
Last Name:ROGERS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 CROTONA PARK E APT 3
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-4829
Mailing Address - Country:US
Mailing Address - Phone:917-803-7694
Mailing Address - Fax:
Practice Address - Street 1:1490 CROTONA PARK E APT 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-4829
Practice Address - Country:US
Practice Address - Phone:917-803-7694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113886104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty