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General NPI Number Information
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NPI Number | 1518753995
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Entity Type | Individual
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Provider Name | MARISSA A ROGERS
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Gender | Female
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 172 BROADWAY
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City | WOODCLIFF LAKE
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State | NJ
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Zip | 07677-8077
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Country | US
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Telephone | 201-373-2282
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Fax |
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Provider Business Mailing Address
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Address Line | 22 BARTHOLDI AVE
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City | HASKELL
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State | NJ
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Zip | 07420-1430
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Country | US
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Telephone | 201-290-7291
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SL07212900
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License Number State | NJ
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