Provider Demographics
NPI:1104437524
Name:ROGERS, ANDREW HARRISON (MA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:HARRISON
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 1/2 S SHERBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2303
Mailing Address - Country:US
Mailing Address - Phone:818-370-5717
Mailing Address - Fax:
Practice Address - Street 1:6404 WILSHIRE BLVD STE 870
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5531
Practice Address - Country:US
Practice Address - Phone:800-624-1475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor