Provider Demographics
NPI:1962712109
Name:ROGOFF, KIRSTEN (MFT)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:ROGOFF
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 174
Mailing Address - Street 2:144 SAN ANTONIO STREET #110
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-0174
Mailing Address - Country:US
Mailing Address - Phone:310-986-0974
Mailing Address - Fax:
Practice Address - Street 1:1090 GOAT SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-0174
Practice Address - Country:US
Practice Address - Phone:310-986-0974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0174911106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist