Provider Demographics
NPI:1942670062
Name:ROGEVICH, MARY (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:ROGEVICH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E 57TH ST
Mailing Address - Street 2:SUITE 35C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2947
Mailing Address - Country:US
Mailing Address - Phone:646-770-6274
Mailing Address - Fax:
Practice Address - Street 1:303 E 57TH ST
Practice Address - Street 2:SUITE 35C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2947
Practice Address - Country:US
Practice Address - Phone:646-770-6274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020640103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist