Provider Demographics
NPI:1760552756
Name:RODGERS, AMBER NICOLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:NICOLE
Last Name:RODGERS
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 1:14496 E WARREN PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1421
Mailing Address - Country:US
Mailing Address - Phone:904-742-8238
Mailing Address - Fax:
Practice Address - Street 1:275 S ASPEN ST
Practice Address - Street 2:
Practice Address - City:BUCKLEY AFB
Practice Address - State:CO
Practice Address - Zip Code:80011-9562
Practice Address - Country:US
Practice Address - Phone:720-847-6451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8729104100000X
NCC0058711041C0700X
FLSW83291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC301100Medicaid
SC301100Medicaid