Provider Demographics
NPI:1689864886
Name:ROGERS, REBECCA SUZANNE (MED MSW LSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUZANNE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MED MSW LSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:SUZANNE
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3430 E RUSSELL RD STE 315
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-2201
Mailing Address - Country:US
Mailing Address - Phone:725-238-6990
Mailing Address - Fax:207-510-0562
Practice Address - Street 1:3430 E RUSSELL RD STE 315
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-2201
Practice Address - Country:US
Practice Address - Phone:725-238-6990
Practice Address - Fax:207-510-0562
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4139-M1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical