Provider Demographics
NPI:1932189321
Name:ROGERS, PATRICIA KATHLEEN (LCSW;DCSW;BCD)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:KATHLEEN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LCSW;DCSW;BCD
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:KATHLEEN
Other - Last Name:POLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:7334 VISTA DEL MAR LN
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-7653
Mailing Address - Country:US
Mailing Address - Phone:310-821-5918
Mailing Address - Fax:
Practice Address - Street 1:7334 VISTA DEL MAR LN
Practice Address - Street 2:
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-7653
Practice Address - Country:US
Practice Address - Phone:310-821-5918
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS16252104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker