Provider Demographics
NPI:1053901025
Name:ROGERS, NAUTICA (MSSA, LSW)
Entity type:Individual
Prefix:MISS
First Name:NAUTICA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:MSSA, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2096 LENNOX RD APT 10
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44106-3246
Mailing Address - Country:US
Mailing Address - Phone:216-420-3613
Mailing Address - Fax:
Practice Address - Street 1:2096 LENNOX RD APT 10
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44106-3246
Practice Address - Country:US
Practice Address - Phone:216-420-3613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker