Provider Demographics
NPI:1114564002
Name:DR. KIRA ROGERS, CLINICAL PSYCHOLOGIST, PLLC
Entity Type:Organization
Organization Name:DR. KIRA ROGERS, CLINICAL PSYCHOLOGIST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:917-714-3177
Mailing Address - Street 1:26 COURT ST STE 1302
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11242-1113
Mailing Address - Country:US
Mailing Address - Phone:917-714-3177
Mailing Address - Fax:
Practice Address - Street 1:26 COURT ST STE 1302
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-1113
Practice Address - Country:US
Practice Address - Phone:917-714-3177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty