MEDICARE: DR. LESLIE S. ROGERS PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PA6178	NC
2	103T00000X	Psychologist

General Provider Information

NPI Number	:	1417666181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE S. ROGERS PSYD

Provider Business Mailing Address
First Line	:	2501 BRAGG BLVD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-4141
Country	:	US
Telephone Number	:	301-636-0419
Fax Number	:	910-338-4713

Provider Business Practice Location Address
First Line	:	2501 BRAGG BLVD BLDG A
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-4141
Country	:	US
Telephone Number	:	301-636-0419
Fax Number	:	910-338-4713

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2022
Last Update Date	:	07/30/2025

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