Provider Demographics
NPI:1083868368
Name:NILAND, ROGER EDWARD (LADC)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:EDWARD
Last Name:NILAND
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MOHAWK DR
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06085-1443
Mailing Address - Country:US
Mailing Address - Phone:860-673-5574
Mailing Address - Fax:
Practice Address - Street 1:22 MOHAWK DR
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:CT
Practice Address - Zip Code:06085-1443
Practice Address - Country:US
Practice Address - Phone:860-673-5574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000502101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)