Provider Demographics
NPI:1396003141
Name:ROGERS, LISA ELLEN (MA,LMFT,LPC,LPCC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ELLEN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MA,LMFT,LPC,LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 E 51ST ST # 264
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-6557
Mailing Address - Country:US
Mailing Address - Phone:646-599-3865
Mailing Address - Fax:
Practice Address - Street 1:245 5TH AVE FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8728
Practice Address - Country:US
Practice Address - Phone:646-599-3865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2023-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178000647101YP2500X
TX19332101YP2500X
NM0137111101YP2500X
TX201088106H00000X
CA43013106H00000X
FLMT3903106H00000X
NJ37FI00197100106H00000X
GAMFT001927106H00000X
VT100.0130890106H00000X
NY001034106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional