Healthcare Provider Details

I. General information

NPI: 1508821703
Provider Name (Legal Business Name): ROGER YEAGER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 PORTLAND AVE
ROCHESTER NY
14621-3036
US

IV. Provider business mailing address

1445 PORTLAND AVE
ROCHESTER NY
14621-3036
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-4698
  • Fax: 585-922-5702
Mailing address:
  • Phone: 585-922-4698
  • Fax: 585-922-5702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number007888
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: