Provider Demographics
NPI:1013966761
Name:ROEGE-PEDERSON, CHERYL B (MED, LMHC, CPRP)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:B
Last Name:ROEGE-PEDERSON
Suffix:
Gender:F
Credentials:MED, LMHC, CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-3216
Mailing Address - Country:US
Mailing Address - Phone:781-760-4110
Mailing Address - Fax:978-937-2513
Practice Address - Street 1:15 VETERANS WAY
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-6108
Practice Address - Country:US
Practice Address - Phone:978-937-9991
Practice Address - Fax:978-937-2513
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1432101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA171617OtherCPRP
MA1432OtherLIC. MEN HLTH COUNSELOR