Individual
MR. DEWAYNE LAVONTE ROGERS I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
132 ROBBS HILL RD, LUNENBURG, MA 01462-2167
(774) 270-1766
Mailing address
9 COMMON ST APT 1L, QUINCY, MA 02169-1663
(857) 251-8996
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
S55356645
MA
Other
Enumeration date
11/26/2019
Last updated
11/26/2019
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