Healthcare Provider Details

I. General information

NPI: 1356590038
Provider Name (Legal Business Name): ROY ROGERS LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 SPRING RD NW
WASHINGTON DC
20010-1421
US

IV. Provider business mailing address

1125 SPRING ROAD NW
WASHINGTON DC
20010-1421
US

V. Phone/Fax

Practice location:
  • Phone: 202-576-8927
  • Fax: 202-576-3203
Mailing address:
  • Phone: 202-576-8927
  • Fax: 202-576-3203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC300175
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: