Provider Demographics
NPI:1942228846
Name:RODGERS, ELIZABETH THOMPSON (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:THOMPSON
Last Name:RODGERS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 GIFFORD STREET
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2969
Mailing Address - Country:US
Mailing Address - Phone:508-495-0554
Mailing Address - Fax:508-495-0559
Practice Address - Street 1:340 GIFFORD ST
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-5105
Practice Address - Country:US
Practice Address - Phone:508-495-0554
Practice Address - Fax:508-495-0557
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1109001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA824163000OtherMAGELLAN
MA1854801Medicaid
MAP08552OtherBCBSMA
MA478922OtherTUFTS
MA000476875OtherVALUE OPTIONS
MA1896164OtherMBHP
MA1854801Medicaid