Provider Demographics
NPI:1568768547
Name:ROGERS, SUSAN H (LMSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:H
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E 3RD ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2638
Mailing Address - Country:US
Mailing Address - Phone:248-691-8500
Mailing Address - Fax:248-246-2244
Practice Address - Street 1:210 E 3RD ST
Practice Address - Street 2:SUITE 210
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2638
Practice Address - Country:US
Practice Address - Phone:248-691-8500
Practice Address - Fax:248-246-2244
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010128811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical