Provider Demographics
NPI:1316220510
Name:ROGERS, CRAIG STEVEN (MFT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:STEVEN
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 3RD ST
Mailing Address - Street 2:APT. 204
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2500
Mailing Address - Country:US
Mailing Address - Phone:818-424-9120
Mailing Address - Fax:866-892-5768
Practice Address - Street 1:3201 WILSHIRE BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-2344
Practice Address - Country:US
Practice Address - Phone:818-424-9120
Practice Address - Fax:866-892-5768
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC14244106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist