Provider Demographics
NPI:1043651953
Name:ROLDAN, CAROL (PSY)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:
Last Name:ROLDAN
Suffix:
Gender:F
Credentials:PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 LA MANCHA MANS. CIUDAD JARDIN
Mailing Address - Street 2:
Mailing Address - City:CAUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-1430
Mailing Address - Country:US
Mailing Address - Phone:787-562-6500
Mailing Address - Fax:
Practice Address - Street 1:169 BUTARE AVE #1
Practice Address - Street 2:PLAZA REAL 207
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-562-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005152103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR005152OtherLICENSE