Provider Demographics
NPI:1215357298
Name:ROLISON, MARY DAY (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:DAY
Last Name:ROLISON
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18181 BUTTERFIELD BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-8119
Mailing Address - Country:US
Mailing Address - Phone:408-513-5107
Mailing Address - Fax:
Practice Address - Street 1:18181 BUTTERFIELD BLVD STE 105
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-8119
Practice Address - Country:US
Practice Address - Phone:408-513-5107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS128231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical