Provider Demographics
NPI:1225297708
Name:ROGERS, JUDITH G (OTR/L)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:G
Last Name:ROGERS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 ADELINE ST
Mailing Address - Street 2:STE. 120
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-2576
Mailing Address - Country:US
Mailing Address - Phone:510-847-1112
Mailing Address - Fax:510-848-4445
Practice Address - Street 1:3075 ADELINE ST
Practice Address - Street 2:STE. 120
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-2576
Practice Address - Country:US
Practice Address - Phone:510-847-1112
Practice Address - Fax:510-848-4445
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 6571101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health