Provider Demographics
NPI:1114139524
Name:ROGERS, KEVIN FRANCIS (LADC1, ASSOC COUN)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:FRANCIS
Last Name:ROGERS
Suffix:
Gender:M
Credentials:LADC1, ASSOC COUN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CLOUGH ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-2609
Mailing Address - Country:US
Mailing Address - Phone:781-596-1458
Mailing Address - Fax:
Practice Address - Street 1:3 CLOUGH ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-2609
Practice Address - Country:US
Practice Address - Phone:781-596-1458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1830101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)