Provider Demographics
NPI:1760948475
Name:ROGERS, RENEE A (LIMITED PERMIT)
Entity Type:Individual
Prefix:MISS
First Name:RENEE
Middle Name:A
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LIMITED PERMIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 E 106TH ST APT 3C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3000
Mailing Address - Country:US
Mailing Address - Phone:718-272-7266
Mailing Address - Fax:
Practice Address - Street 1:19 W 34TH ST # 13
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3006
Practice Address - Country:US
Practice Address - Phone:212-947-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health