Provider Demographics
NPI:1851514152
Name:ROGERS, MARIE A (LMHC)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:A
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5945 NORTHWEST 71 TERRACE
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067
Mailing Address - Country:US
Mailing Address - Phone:954-649-1102
Mailing Address - Fax:954-755-3134
Practice Address - Street 1:5945 NW 71ST TER
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-1205
Practice Address - Country:US
Practice Address - Phone:954-649-1102
Practice Address - Fax:954-755-3134
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5795101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health