Provider Demographics
NPI:1356484489
Name:ROLLAND, CAROL P (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:P
Last Name:ROLLAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 N ASTOR ST
Mailing Address - Street 2:APT. 6B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-1672
Mailing Address - Country:US
Mailing Address - Phone:312-643-5177
Mailing Address - Fax:
Practice Address - Street 1:3040 N WILTON AVE
Practice Address - Street 2:PEDIATRIC DEVELOPMENTAL CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4424
Practice Address - Country:US
Practice Address - Phone:773-296-7340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist