Provider Demographics
NPI:1548286271
Name:ROGERS, CAROLYN ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:ANN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:CAROLYN
Other - Middle Name:ANN
Other - Last Name:KNERR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2450 PERALTA BLVD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-3827
Mailing Address - Country:US
Mailing Address - Phone:510-792-6906
Mailing Address - Fax:510-652-7299
Practice Address - Street 1:2450 PERALTA BLVD
Practice Address - Street 2:SUITE 212
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-3827
Practice Address - Country:US
Practice Address - Phone:510-792-6906
Practice Address - Fax:510-652-7299
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 56031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical