Provider Demographics
NPI:1932669959
Name:FOSTER, ROGER MARIS (LMSW)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:MARIS
Last Name:FOSTER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 DONNA DR
Mailing Address - Street 2:
Mailing Address - City:BAITING HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:11933-1386
Mailing Address - Country:US
Mailing Address - Phone:631-379-0900
Mailing Address - Fax:
Practice Address - Street 1:214 DONNA DR
Practice Address - Street 2:
Practice Address - City:BAITING HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:11933-1386
Practice Address - Country:US
Practice Address - Phone:631-379-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker