Provider Demographics
NPI:1245563303
Name:RODGERS, CARYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARYN
Middle Name:
Last Name:RODGERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 MORRIS PARK AVE
Mailing Address - Street 2:VE BLDG #5, RM 6B19
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1900
Mailing Address - Country:US
Mailing Address - Phone:718-862-7172
Mailing Address - Fax:
Practice Address - Street 1:111 E 210TH ST
Practice Address - Street 2:KLAU
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:646-546-9389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017964103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist