Healthcare Provider Details

I. General information

NPI: 1295759231
Provider Name (Legal Business Name): LEROY F ROGERS APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BOND ST
SPRINGFIELD MA
01104-3401
US

IV. Provider business mailing address

9 STERLING DR
EASTHAMPTON MA
01027-2504
US

V. Phone/Fax

Practice location:
  • Phone: 413-731-6080
  • Fax: 413-788-4617
Mailing address:
  • Phone: 413-527-8540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number135114
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: