Provider Demographics
NPI:1861480550
Name:RODGERS, TERESA B (RN LCSW)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:B
Last Name:RODGERS
Suffix:
Gender:F
Credentials:RN LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 NEWBRIDGE RD
Mailing Address - Street 2:APT 74
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-5234
Mailing Address - Country:US
Mailing Address - Phone:516-781-8206
Mailing Address - Fax:
Practice Address - Street 1:650 NEWBRIDGE RD
Practice Address - Street 2:APT 74
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-5234
Practice Address - Country:US
Practice Address - Phone:516-781-8206
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR043391-11041C0700X
NY776011-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN26B01Medicare ID - Type Unspecified