MEDICARE: MARK H ROGAN 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
1	1041C0700X	Clinical Social Worker	LSW4366	TN

General Provider Information

NPI Number	:	1902069362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK H ROGAN LCSW

Provider Business Mailing Address
First Line	:	1027 S YATES RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-3707
Country	:	US
Telephone Number	:	901-682-6136
Fax Number	:	901-682-7136

Provider Business Practice Location Address
First Line	:	1027 S YATES RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-3707
Country	:	US
Telephone Number	:	901-682-6136
Fax Number	:	901-682-7136

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

Provider Enumeration Date	:	07/07/2008
Last Update Date	:	07/07/2008

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