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General NPI Number Information
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NPI Number | 1174994537
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Entity Type | Individual
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Provider Name | JEANETTE B. ROGERS LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/12/2015
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Last Update Date | 09/06/2019
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Provider Practice Location Address
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Address Line | 43 COLUMBIA STREET, SUITE 11
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City | BANGOR
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State | ME
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Zip | 04401
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Country | US
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Telephone | 207-217-0679
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Fax | 207-573-4666
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Provider Business Mailing Address
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Address Line | 503 FIVE ROAD
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City | CARMEL
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State | ME
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Zip | 04419
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Country | US
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Telephone | 207-217-0679
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Fax | 207-573-4666
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC16730
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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