Provider Demographics
NPI:1366154247
Name:ROGERS, CHARLEANNE MACKENZI (BCBA)
Entity type:Individual
Prefix:
First Name:CHARLEANNE
Middle Name:MACKENZI
Last Name:ROGERS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:CHUCK
Other - Middle Name:MACKENZI
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA
Mailing Address - Street 1:6060 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1907
Mailing Address - Country:US
Mailing Address - Phone:317-815-5501
Mailing Address - Fax:
Practice Address - Street 1:23 CROSBY DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1423
Practice Address - Country:US
Practice Address - Phone:781-832-3146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst