Provider Demographics
NPI:1356590038
Name:ROGERS, ROY (LICSW)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:ROGERS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 SPRING ROAD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-1421
Mailing Address - Country:US
Mailing Address - Phone:202-576-8927
Mailing Address - Fax:202-576-3203
Practice Address - Street 1:1125 SPRING RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-1421
Practice Address - Country:US
Practice Address - Phone:202-576-8927
Practice Address - Fax:202-576-3203
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3001751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical