Healthcare Provider Details

I. General information

NPI: 1508264672
Provider Name (Legal Business Name): AMY ROGERS, MA, LPC,NCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 MOOSIC RD
OLD FORGE PA
18518-2082
US

IV. Provider business mailing address

2652 CEDAR AVE
SCRANTON PA
18505
US

V. Phone/Fax

Practice location:
  • Phone: 570-604-4393
  • Fax:
Mailing address:
  • Phone: 570-604-4393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC007399
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. AMY ELIZABETH ROGERS
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: MA, LPC,NCC
Phone: 570-604-4393