Provider Demographics
NPI:1194824045
Name:ROGERSON, ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:
Last Name:ROGERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 CONCORD PIKE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803
Mailing Address - Country:US
Mailing Address - Phone:302-428-0205
Mailing Address - Fax:302-428-1123
Practice Address - Street 1:1521 CONCORD PIKE
Practice Address - Street 2:SUITE 103
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803
Practice Address - Country:US
Practice Address - Phone:302-428-0205
Practice Address - Fax:302-428-1123
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ10000452104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE172612OtherCOMPSYCH
DE172612OtherCOMPSYCH
000G08A31Medicare ID - Type Unspecified