Provider Demographics
NPI:1073674610
Name:ROGERS, CAROL R (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:R
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 GLENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-2009
Mailing Address - Country:US
Mailing Address - Phone:781-275-6452
Mailing Address - Fax:
Practice Address - Street 1:1 GARFIELD CIR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4983
Practice Address - Country:US
Practice Address - Phone:617-529-4495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110256101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAROP22712Medicare ID - Type UnspecifiedMEDICARE B PROGRAM