Basic Information
| Provider Information | |||||||||
| NPI: | 1396908117 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROGOFF | ||||||||
| FirstName: | LAURIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31500 SCHOOLCRAFT RD | ||||||||
| Address2: | |||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481501805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344229340 | ||||||||
| FaxNumber: | 7344229353 | ||||||||
| Practice Location | |||||||||
| Address1: | 31500 SCHOOLCRAFT RD | ||||||||
| Address2: | |||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481501805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344229340 | ||||||||
| FaxNumber: | 7344229353 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2008 | ||||||||
| LastUpdateDate: | 08/30/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401008979 | MI | N | Behavioral Health & Social Service Providers | Counselor | Professional | 103TC0700X | 6301015469 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.