Provider Demographics
NPI:1750447736
Name:RODGERS, STACEY ANN (MFT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:ANN
Last Name:RODGERS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 MARKET ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-5402
Mailing Address - Country:US
Mailing Address - Phone:415-255-2165
Mailing Address - Fax:415-255-2101
Practice Address - Street 1:1390 MARKET ST
Practice Address - Street 2:SUITE 800
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-5402
Practice Address - Country:US
Practice Address - Phone:415-255-2165
Practice Address - Fax:415-255-2101
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47227106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist