Provider Demographics
NPI:1326587718
Name:ROGERS, LAURA (LGSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 AVONDALE RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-7062
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1664 WINCHESTER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25405-3881
Practice Address - Country:US
Practice Address - Phone:304-901-4347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-17
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00942130104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker