Provider Demographics
NPI:1326254814
Name:ROGG, JASMIN (MA, MFT)
Entity Type:Individual
Prefix:MRS
First Name:JASMIN
Middle Name:
Last Name:ROGG
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4413 CAMERO AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5507
Mailing Address - Country:US
Mailing Address - Phone:310-617-9324
Mailing Address - Fax:
Practice Address - Street 1:337 S BEVERLY DR STE 101
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4307
Practice Address - Country:US
Practice Address - Phone:310-617-9324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39197106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist