Healthcare Provider Details

I. General information

NPI: 1639992969
Provider Name (Legal Business Name): JEFFREY ROGERS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2573 STATE HIGHWAY 522
QUESTA NM
87556
US

IV. Provider business mailing address

2573 STATE HIGHWAY 522
QUESTA NM
87556
US

V. Phone/Fax

Practice location:
  • Phone: 575-586-0331
  • Fax: 505-443-8353
Mailing address:
  • Phone: 575-586-0331
  • Fax: 505-443-8353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2025-0572
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: