Provider Demographics
NPI:1780225557
Name:ROGERS, KEBA MARGUERITA
Entity Type:Individual
Prefix:DR
First Name:KEBA
Middle Name:MARGUERITA
Last Name:ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 3RD AVE STE 1OFFICE1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3459
Mailing Address - Country:US
Mailing Address - Phone:917-500-4948
Mailing Address - Fax:
Practice Address - Street 1:1619 3RD AVE STE 1OFFICE1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3459
Practice Address - Country:US
Practice Address - Phone:917-500-4948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019236103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist