MEDICARE: MRS. PATRICIA KATHLEEN ROGERS LCSW;DCSW;BCD

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	104100000X	Social Worker	LCS16252	CA

General Provider Information

NPI Number	:	1932189321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA KATHLEEN ROGERS LCSW;DCSW;BCD

Provider Business Mailing Address
First Line	:	7334 VISTA DEL MAR LN
Second Line	:
City	:	PLAYA DEL REY
State	:	CA
Zip	:	90293-7653
Country	:	US
Telephone Number	:	310-821-5918
Fax Number	:

Provider Business Practice Location Address
First Line	:	7334 VISTA DEL MAR LN
Second Line	:
City	:	PLAYA DEL REY
State	:	CA
Zip	:	90293-7653
Country	:	US
Telephone Number	:	310-821-5918
Fax Number	:

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	07/08/2007

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