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NPI Code Detail

MEDICARE: MR. ROGER DUANE EAKS LCSW

MEDICARE: MR. ROGER DUANE EAKS LCSW
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
1104100000XSocial Worker228CO

General Provider Information

NPI Number : 1255320206
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROGER DUANE EAKS LCSW
Provider Business Mailing Address
First Line : USA MEDDAC
Second Line : 11050 MT. BELVEDERE BLVD
City : FORT DRUM
State : NY
Zip : 13602
Country : US
Telephone Number : 315-772-4025
Fax Number : 315-772-9498
Provider Business Practice Location Address
First Line : USA MEDDAC ATTN: CREDENTIALS
Second Line : 11050 MT BELVEDERE BLVD
City : FORT DRUM
State : NY
Zip : 13602-5004
Country : US
Telephone Number : 315-772-4025
Fax Number : 315-772-9498
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2005
Last Update Date : 01/24/2022

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