Provider Demographics
NPI:1437881968
Name:SHAWN RODGERS LCPC LLC
Entity Type:Organization
Organization Name:SHAWN RODGERS LCPC LLC
Other - Org Name:SHAWN RODGERS LCPC LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/EMPLOYEE
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:207-701-1762
Mailing Address - Street 1:66 W STREET EXT
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-5133
Mailing Address - Country:US
Mailing Address - Phone:207-701-1762
Mailing Address - Fax:
Practice Address - Street 1:17 MASONIC ST
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2808
Practice Address - Country:US
Practice Address - Phone:207-701-1762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-24
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)