Provider Demographics
NPI:1255472536
Name:ROLL, CAROLYN NORA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:NORA
Last Name:ROLL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5413 MERIDIAN AVE N
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6168
Mailing Address - Country:US
Mailing Address - Phone:206-545-7500
Mailing Address - Fax:206-632-4767
Practice Address - Street 1:5413 MERIDIAN AVE N
Practice Address - Street 2:SUITE A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6168
Practice Address - Country:US
Practice Address - Phone:206-545-7500
Practice Address - Fax:206-632-4767
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2241103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical