Provider Demographics
NPI:1992864953
Name:ROGERSON, COREEN MOREHOUSE (LCSW,ACSW)
Entity Type:Individual
Prefix:
First Name:COREEN
Middle Name:MOREHOUSE
Last Name:ROGERSON
Suffix:
Gender:F
Credentials:LCSW,ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 LILA ST
Mailing Address - Street 2:CH FAMILY MEDICINE CENTER/UFJHI
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-3550
Mailing Address - Country:US
Mailing Address - Phone:904-383-1990
Mailing Address - Fax:904-383-1991
Practice Address - Street 1:1255 LILA ST
Practice Address - Street 2:CH FAMILY MEDICINE CENTER/UFJHI
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-3550
Practice Address - Country:US
Practice Address - Phone:904-383-1990
Practice Address - Fax:904-383-1991
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00044651041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHQ247XMedicare PIN
FLHQ247YMedicare PIN
FLHQ247WMedicare PIN