Provider Demographics
NPI:1073274767
Name:ROGERS, STEPHANIE RENE (N/A)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:RENE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 CASSADY ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-4636
Mailing Address - Country:US
Mailing Address - Phone:707-267-1049
Mailing Address - Fax:
Practice Address - Street 1:207 CASSADY ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-4636
Practice Address - Country:US
Practice Address - Phone:707-267-1049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health