Provider Demographics
NPI:1265825640
Name:ROGERS, JOSEPH EDWARD (CSAC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:EDWARD
Last Name:ROGERS
Suffix:
Gender:M
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2294
Mailing Address - Street 2:
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-2202
Mailing Address - Country:US
Mailing Address - Phone:808-332-0262
Mailing Address - Fax:
Practice Address - Street 1:614 KILAUEA AVE
Practice Address - Street 2:SUITE 102A
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4272
Practice Address - Country:US
Practice Address - Phone:808-339-0262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1816-14101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)