Provider Demographics
NPI:1578700514
Name:ROGAN, BRENDAN LAINE
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:LAINE
Last Name:ROGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 PELHAM PKWY N
Mailing Address - Street 2:STE. 402
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-8032
Mailing Address - Country:US
Mailing Address - Phone:718-519-8326
Mailing Address - Fax:718-881-8714
Practice Address - Street 1:655 PELHAM PKWY N
Practice Address - Street 2:STE. 402
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-8032
Practice Address - Country:US
Practice Address - Phone:718-519-8326
Practice Address - Fax:718-881-8714
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker