Healthcare Provider Details

I. General information

NPI: 1760552756
Provider Name (Legal Business Name): AMBER NICOLE RODGERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 03/06/2021
Certification Date: 03/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 S ASPEN ST
BUCKLEY AFB CO
80011-9562
US

IV. Provider business mailing address

14496 E WARREN PL
AURORA CO
80014-1421
US

V. Phone/Fax

Practice location:
  • Phone: 720-847-6451
  • Fax:
Mailing address:
  • Phone: 904-742-8238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8729
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC005871
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW8329
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: