Provider Demographics
NPI:1447719620
Name:LONG-ROGERS, DYNISE (CRS,BAS,CPS)
Entity type:Individual
Prefix:MRS
First Name:DYNISE
Middle Name:
Last Name:LONG-ROGERS
Suffix:
Gender:F
Credentials:CRS,BAS,CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-2940
Mailing Address - Country:US
Mailing Address - Phone:412-243-3400
Mailing Address - Fax:
Practice Address - Street 1:716 WOOD ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221-2818
Practice Address - Country:US
Practice Address - Phone:412-243-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist