Provider Demographics
NPI:1104401264
Name:RODGERS, ETHEL CABANAS (LMHC)
Entity Type:Individual
Prefix:
First Name:ETHEL
Middle Name:CABANAS
Last Name:RODGERS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 RTE 81
Mailing Address - Street 2:
Mailing Address - City:WEST COXSACKIE
Mailing Address - State:NY
Mailing Address - Zip Code:12192-1202
Mailing Address - Country:US
Mailing Address - Phone:518-731-1955
Mailing Address - Fax:
Practice Address - Street 1:104 RTE 81
Practice Address - Street 2:
Practice Address - City:WEST COXSACKIE
Practice Address - State:NY
Practice Address - Zip Code:12192-1202
Practice Address - Country:US
Practice Address - Phone:518-731-1955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014033101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health