Provider Demographics
NPI:1265689822
Name:ROGERS, SAMUEL TROY (LCSW)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:TROY
Last Name:ROGERS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 GLEASON ST
Mailing Address - Street 2:
Mailing Address - City:BRUSLY
Mailing Address - State:LA
Mailing Address - Zip Code:70719-2565
Mailing Address - Country:US
Mailing Address - Phone:225-247-5700
Mailing Address - Fax:
Practice Address - Street 1:940 GOVERNMENT ST
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-3633
Practice Address - Country:US
Practice Address - Phone:225-665-7242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA38091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical