Healthcare Provider Details

I. General information

NPI: 1649586959
Provider Name (Legal Business Name): JENNIFER B ROGERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 MAIN ST STE 211
MANCHESTER CT
06040-6064
US

IV. Provider business mailing address

745 MERROW RD APT 149
COVENTRY CT
06238-1370
US

V. Phone/Fax

Practice location:
  • Phone: 860-792-6298
  • Fax:
Mailing address:
  • Phone: 860-306-5575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number008422
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: