Provider Demographics
NPI:1689267825
Name:ROGERS, TANYA (LMSW)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 MEDICAL CENTER DR STE 106
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-3711
Mailing Address - Country:US
Mailing Address - Phone:410-200-9290
Mailing Address - Fax:
Practice Address - Street 1:9600 MEDICAL CENTER DR.
Practice Address - Street 2:SUITE 106
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-3711
Practice Address - Country:US
Practice Address - Phone:410-200-9290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20389101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health