Healthcare Provider Details

I. General information

NPI: 1336468677
Provider Name (Legal Business Name): KATE V RODGERS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 CHAPEL AVE W
CHERRY HILL NJ
08002-2048
US

IV. Provider business mailing address

2201 CHAPEL AVE WEST
CHERRY HILL NJ
08002
US

V. Phone/Fax

Practice location:
  • Phone: 856-488-6792
  • Fax: 856-488-6454
Mailing address:
  • Phone: 856-488-6792
  • Fax: 856-488-6454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00383500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: