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General NPI Number Information
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NPI Number | 1245563303
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Entity Type | Individual
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Provider Name | CARYN RODGERS PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/08/2009
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Last Update Date | 07/12/2011
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Provider Practice Location Address
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Address Line | 111 E 210TH ST KLAU
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City | BRONX
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State | NY
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Zip | 10467-2401
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Country | US
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Telephone | 646-546-9389
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 MORRIS PARK AVE VE BLDG #5, RM 6B19
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City | BRONX
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State | NY
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Zip | 10461-1900
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Country | US
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Telephone | 718-862-7172
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 017964
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License Number State | NY
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