Provider Demographics
NPI:1417024647
Name:ROGGE, CATHY L (EDM LMFT LCSW)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:L
Last Name:ROGGE
Suffix:
Gender:F
Credentials:EDM LMFT LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CENTRE STREET
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1422
Mailing Address - Country:US
Mailing Address - Phone:978-774-5288
Mailing Address - Fax:978-774-5288
Practice Address - Street 1:105 CENTRE STREET
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1422
Practice Address - Country:US
Practice Address - Phone:978-774-5288
Practice Address - Fax:978-774-5288
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA885106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
138346OtherVALUE OPTIONS