Provider Demographics
NPI:1992861082
Name:DUKE, ROGER (LMFT)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:
Last Name:DUKE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SUNRISE AVE
Mailing Address - Street 2:SUITE12
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4679
Mailing Address - Country:US
Mailing Address - Phone:209-499-9189
Mailing Address - Fax:
Practice Address - Street 1:1600 SUNRISE AVE
Practice Address - Street 2:SUITE12
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4679
Practice Address - Country:US
Practice Address - Phone:209-499-9189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36504106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist