Provider Demographics
NPI:1265742597
Name:ROGERS, LISA BETH (LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:BETH
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 1:16 RAE PALMER RD
Mailing Address - Street 2:
Mailing Address - City:MOODUS
Mailing Address - State:CT
Mailing Address - Zip Code:06469-1195
Mailing Address - Country:US
Mailing Address - Phone:860-967-8941
Mailing Address - Fax:860-891-8092
Practice Address - Street 1:16 RAE PALMER RD
Practice Address - Street 2:
Practice Address - City:MOODUS
Practice Address - State:CT
Practice Address - Zip Code:06469-1195
Practice Address - Country:US
Practice Address - Phone:860-615-6152
Practice Address - Fax:860-891-8092
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0085201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical