Provider Demographics
NPI:1528066727
Name:ROGERS, MORGAN LAVENIA (LISW)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:LAVENIA
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 FAIRGLADE LN
Mailing Address - Street 2:APT C
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-3143
Mailing Address - Country:US
Mailing Address - Phone:614-500-8122
Mailing Address - Fax:
Practice Address - Street 1:5900 SAWMILL RD
Practice Address - Street 2:SUITE 210
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3538
Practice Address - Country:US
Practice Address - Phone:614-717-9652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI10002941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3987418Medicare PIN