Healthcare Provider Details

I. General information

NPI: 1134064256
Provider Name (Legal Business Name): ROGERS MENTAL WELLNESS SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 TEXAS AVE
BRIDGEPORT CT
06610-1813
US

IV. Provider business mailing address

251 TEXAS AVE
BRIDGEPORT CT
06610-1813
US

V. Phone/Fax

Practice location:
  • Phone: 203-218-0752
  • Fax:
Mailing address:
  • Phone: 203-218-0752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. RENEE ROGERS
Title or Position: OWNER
Credential: LPC
Phone: 203-218-0752