MEDICARE: DR. TRACEY L. ROGERS PH.D.

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
1	103T00000X	Psychologist	6374	MA

General Provider Information

NPI Number	:	1851467120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACEY L. ROGERS PH.D.

Provider Business Mailing Address
First Line	:	23 HARRISON ST
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02461-1324
Country	:	US
Telephone Number	:	617-515-7750
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 LINCOLN ST
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02461-1524
Country	:	US
Telephone Number	:	617-515-7750
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/08/2007

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