Provider Demographics
NPI:1548278625
Name:ROGERS, STEPHANIE ANN (MSSW, MDIV, LCSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MSSW, MDIV, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3837 CENTENARY AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-5226
Mailing Address - Country:US
Mailing Address - Phone:214-363-1378
Mailing Address - Fax:
Practice Address - Street 1:1110 N BUCKNER BLVD STE 102
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3498
Practice Address - Country:US
Practice Address - Phone:214-320-9000
Practice Address - Fax:214-320-9441
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX230781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical