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General NPI Number Information
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NPI Number | 1073674610
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Entity Type | Individual
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Provider Name | CAROL R. ROGERS L.I.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 GARFIELD CIR
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City | BURLINGTON
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State | MA
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Zip | 01803-4983
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Country | US
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Telephone | 617-529-4495
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Fax |
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Provider Business Mailing Address
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Address Line | 47 GLENRIDGE DR
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City | BEDFORD
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State | MA
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Zip | 01730-2009
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Country | US
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Telephone | 781-275-6452
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 110256
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License Number State | MA
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