Provider Demographics
NPI:1275737181
Name:ROGERS, LINDA (PHD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:ROGERS
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 1:5513 LEGACY CRESCENT PL
Mailing Address - Street 2:APT. 102
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-2814
Mailing Address - Country:US
Mailing Address - Phone:813-349-9670
Mailing Address - Fax:
Practice Address - Street 1:5513 LEGACY CRESCENT PL
Practice Address - Street 2:APT. 102
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-2814
Practice Address - Country:US
Practice Address - Phone:813-349-9670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7346103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist