Provider Demographics
NPI:1679626378
Name:ROGERS, SUSAN MORGAN (PSYD, LP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MORGAN
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MORGAN
Other - Last Name:COOKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:123 UNION ST
Mailing Address - Street 2:STE 101-12
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-4100
Mailing Address - Country:US
Mailing Address - Phone:413-224-8123
Mailing Address - Fax:
Practice Address - Street 1:123 UNION ST
Practice Address - Street 2:STE 101-12
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-4100
Practice Address - Country:US
Practice Address - Phone:413-224-8123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA10853103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health