Individual
KELLY FORBES ROGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
29 CHESTERFIELD RD, EAST LYME, CT 06333-0094
(860) 739-6974
(860) 739-5290
Mailing address
PO BOX 94, 29 CHESTERFIELD RD, EAST LYME, CT 06333-0094
(860) 739-6974
(860) 739-5290
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
001911
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004138691
—
CT
01
—
060001911CT03
ANTHEM
—
01
—
P1033995
OXFORD
—
Enumeration date
04/16/2007
Last updated
07/08/2007
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