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General NPI Number Information
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NPI Number | 1154885887
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Entity Type | Individual
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Provider Name | ROBERT ROGERS
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Gender | Male
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Dates
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Enumeration Date | 01/28/2019
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Last Update Date | 03/22/2021
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Provider Practice Location Address
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Address Line | 314 WYNDHURST AVE
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City | BALTIMORE
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State | MD
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Zip | 21210-2416
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Country | US
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Telephone | 443-681-9935
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Fax | 443-687-8662
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Provider Business Mailing Address
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Address Line | 203 MURDOCK RD
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City | BALTIMORE
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State | MD
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Zip | 21212-1824
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Country | US
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Telephone | 407-721-5947
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LGP9063
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC10874
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License Number State | MD
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