Provider Demographics
NPI:1437393451
Name:ROLDAN, GLENDA (MA)
Entity Type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:
Last Name:ROLDAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 IRISE CT APT 203
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3748
Mailing Address - Country:US
Mailing Address - Phone:407-736-1040
Mailing Address - Fax:407-736-0310
Practice Address - Street 1:1485 S SEMORAN BLVD
Practice Address - Street 2:SUITE 1402
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-5533
Practice Address - Country:US
Practice Address - Phone:407-736-1040
Practice Address - Fax:407-736-0310
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0424OtherDATE OF BIRTH