Provider Demographics
NPI:1497924211
Name:ROGERS, RANDALL (PHD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:
Last Name:ROGERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 E ALLEN APT. D
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404
Mailing Address - Country:US
Mailing Address - Phone:615-202-9993
Mailing Address - Fax:802-656-5793
Practice Address - Street 1:1 S PROSPECT ST
Practice Address - Street 2:1415
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-3456
Practice Address - Country:US
Practice Address - Phone:802-656-8714
Practice Address - Fax:802-656-5793
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist