Provider Demographics
NPI:1194028415
Name:ROLDAN, KEISHA (MSW)
Entity Type:Individual
Prefix:MRS
First Name:KEISHA
Middle Name:
Last Name:ROLDAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 917
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-0917
Mailing Address - Country:US
Mailing Address - Phone:787-374-2253
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 905 KM 2.2
Practice Address - Street 2:BARRIO TEJAS
Practice Address - City:YAHUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767-0000
Practice Address - Country:US
Practice Address - Phone:787-374-2253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR92411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical