Provider Demographics
NPI:1558399881
Name:RODGERS, RICHARD L (LCSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:RODGERS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-8302
Mailing Address - Country:US
Mailing Address - Phone:844-294-5306
Mailing Address - Fax:844-294-5306
Practice Address - Street 1:189 APPLEGARTH RD
Practice Address - Street 2:
Practice Address - City:MONROE TWP
Practice Address - State:NJ
Practice Address - Zip Code:08831-5961
Practice Address - Country:US
Practice Address - Phone:609-448-7045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJPENDINGMedicare ID - Type Unspecified