Provider Demographics
NPI:1730630922
Name:ROGERS, STEVEN (RADT1)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:ROGERS
Suffix:
Gender:M
Credentials:RADT1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E WASHINGTON AVE
Mailing Address - Street 2:#100
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-1806
Mailing Address - Country:US
Mailing Address - Phone:760-741-7708
Mailing Address - Fax:760-741-5421
Practice Address - Street 1:200 E WASHINGTON AVE
Practice Address - Street 2:#100
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-1806
Practice Address - Country:US
Practice Address - Phone:760-741-7708
Practice Address - Fax:760-741-5421
Is Sole Proprietor?:No
Enumeration Date:2016-10-22
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)