Provider Demographics
NPI:1255413068
Name:ROGERS, PATRICIA A (LCSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CANTERBURY CIR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10992-1134
Mailing Address - Country:US
Mailing Address - Phone:845-304-7913
Mailing Address - Fax:
Practice Address - Street 1:120 N MAIN ST
Practice Address - Street 2:STE 207
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3743
Practice Address - Country:US
Practice Address - Phone:845-304-7913
Practice Address - Fax:845-638-5971
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR057702-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02635638Medicaid