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NPI Code Detail

MEDICARE: STEPHEN ROGERS MS

MEDICARE: STEPHEN ROGERS MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorA013830315CA
2106H00000XMarriage & Family Therapist105277CA

General Provider Information

NPI Number : 1235358821
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN ROGERS MS
Provider Business Mailing Address
First Line : 2644 30TH ST STE 100
Second Line :
City : SANTA MONICA
State : CA
Zip : 90405-3051
Country : US
Telephone Number : 310-314-6200
Fax Number : 310-450-2024
Provider Business Practice Location Address
First Line : 5220 W WASHINGTON BLVD
Second Line : SUITE 101
City : LOS ANGELES
State : CA
Zip : 90016-1331
Country : US
Telephone Number : 323-933-9186
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2007
Last Update Date : 07/09/2021

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