Provider Demographics
NPI:1407914971
Name:ROLLE, LISA LYNN (LCSW-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LYNN
Last Name:ROLLE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19038 FESTIVAL DR
Mailing Address - Street 2:
Mailing Address - City:BOYDS
Mailing Address - State:MD
Mailing Address - Zip Code:20841-4002
Mailing Address - Country:US
Mailing Address - Phone:301-515-5998
Mailing Address - Fax:301-840-8972
Practice Address - Street 1:15201 SHADY GROVE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3217
Practice Address - Country:US
Practice Address - Phone:301-948-4395
Practice Address - Fax:301-840-8972
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD069251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD491028Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER