Provider Demographics
NPI:1689186900
Name:ROGERSON, JENNA MACGILLIVRAY (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MACGILLIVRAY
Last Name:ROGERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 JAVA RD
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-3075
Mailing Address - Country:US
Mailing Address - Phone:407-761-4737
Mailing Address - Fax:
Practice Address - Street 1:10129 CLEAR VISTA ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-7164
Practice Address - Country:US
Practice Address - Phone:833-663-6331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
FLSW180641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical