Provider Demographics
NPI:1891145306
Name:ROGERS, HARVEY IRA I (CASAC)
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:IRA
Last Name:ROGERS
Suffix:I
Gender:M
Credentials:CASAC
Other - Prefix:MR
Other - First Name:HARVEY
Other - Middle Name:IRA
Other - Last Name:ROGERS
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:CASAC
Mailing Address - Street 1:100 ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:AIRMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4927
Mailing Address - Country:US
Mailing Address - Phone:845-369-9701
Mailing Address - Fax:845-369-1004
Practice Address - Street 1:100 ROUTE 59
Practice Address - Street 2:
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10901-4927
Practice Address - Country:US
Practice Address - Phone:845-369-9701
Practice Address - Fax:845-369-1004
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19655101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY19655OtherCASAC