Provider Demographics
NPI:1295823375
Name:ROGERS, ANTHONY COLA (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:COLA
Last Name:ROGERS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 HARVARD ST
Mailing Address - Street 2:#6
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1561
Mailing Address - Country:US
Mailing Address - Phone:310-453-8837
Mailing Address - Fax:310-453-8837
Practice Address - Street 1:2730 WILSHIRE BLVD
Practice Address - Street 2:STE. 630
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4743
Practice Address - Country:US
Practice Address - Phone:310-840-7543
Practice Address - Fax:310-453-8837
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA162581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0449964OtherMENTAL HEALTH NETWORK
CASW26484AMedicare ID - Type Unspecified