Provider Demographics
NPI:1700914215
Name:ROGERS, SYLVIA DOREEN (LCSWC)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:DOREEN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1339 VALLEYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-1243
Mailing Address - Country:US
Mailing Address - Phone:410-869-9091
Mailing Address - Fax:
Practice Address - Street 1:1339 VALLEYBROOK RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-1243
Practice Address - Country:US
Practice Address - Phone:410-869-9091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD070971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
QV83SDOtherBLUECROSS BLUESHIELD