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NPI Code Detail

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

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
1103T00000XPsychologist6374MA

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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Directions to “ DR. TRACEY L. ROGERS PH.D.” Practice Location

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