Provider Demographics
NPI:1689169823
Name:ROGERSON, MEREDITH SARGENT (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:SARGENT
Last Name:ROGERSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:578 ANDOVER ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1443
Mailing Address - Country:US
Mailing Address - Phone:561-866-5344
Mailing Address - Fax:
Practice Address - Street 1:578 ANDOVER ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1443
Practice Address - Country:US
Practice Address - Phone:561-866-5344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221411251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health