Healthcare Provider Details

I. General information

NPI: 1699822874
Provider Name (Legal Business Name): AMY F ROGERS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 MISSION AVE
SAN RAFAEL CA
94901-6106
US

IV. Provider business mailing address

135 REDWOOD AVE APT 7
CORTE MADERA CA
94925-1462
US

V. Phone/Fax

Practice location:
  • Phone: 415-456-9350
  • Fax: 415-456-1508
Mailing address:
  • Phone: 415-456-9350
  • Fax: 415-456-1508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: