Individual
ELLIOT ROGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
110 BOSTON ST, SALEM, MA 01970-1402
(860) 416-4076
Mailing address
110 BOSTON ST, SALEM, MA 01970-1402
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
Primary
—
—
104100000X
Social Worker
—
—
Other
Enumeration date
12/23/2015
Last updated
12/23/2015
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