Provider Demographics
NPI:1982810537
Name:ROGERS, DUANE EDWARD (MFT)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:EDWARD
Last Name:ROGERS
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 HARTFORD ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2338
Mailing Address - Country:US
Mailing Address - Phone:619-275-2320
Mailing Address - Fax:619-275-2320
Practice Address - Street 1:2321 HARTFORD ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-2338
Practice Address - Country:US
Practice Address - Phone:619-275-2320
Practice Address - Fax:619-275-2320
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42324106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist