Healthcare Provider Details

I. General information

NPI: 1932368024
Provider Name (Legal Business Name): RONI ROGERS MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 KEOFFERAM RD
OLD GREENWICH CT
06870-2112
US

IV. Provider business mailing address

9 KEOFFERAM RD
OLD GREENWICH CT
06870-2112
US

V. Phone/Fax

Practice location:
  • Phone: 203-637-4467
  • Fax:
Mailing address:
  • Phone: 203-637-4467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000153
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: