Provider Demographics
NPI:1043220734
Name:ROGERS, SUSAN (LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23123 VENTURA BLVD STE 202A
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1117
Mailing Address - Country:US
Mailing Address - Phone:818-880-2248
Mailing Address - Fax:
Practice Address - Street 1:4505 LAS VIRGENES RD
Practice Address - Street 2:#217
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302
Practice Address - Country:US
Practice Address - Phone:818-880-2248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 140841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW14084Medicare ID - Type UnspecifiedSOCIAL WORK