Provider Demographics
NPI:1255734786
Name:RODGERS, SELENA T (PHD, LCSW-R)
Entity type:Individual
Prefix:DR
First Name:SELENA
Middle Name:T
Last Name:RODGERS
Suffix:
Gender:F
Credentials:PHD, LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163-27 130TH AVENUE
Mailing Address - Street 2:#6F
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-3039
Mailing Address - Country:US
Mailing Address - Phone:718-949-3048
Mailing Address - Fax:
Practice Address - Street 1:163-27 130TH AVE
Practice Address - Street 2:#6F
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-3039
Practice Address - Country:US
Practice Address - Phone:718-949-3048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR052271-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical