Provider Demographics
NPI:1437834470
Name:ROLDAN, JESSIKA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:JESSIKA
Middle Name:
Last Name:ROLDAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JESS
Other - Middle Name:
Other - Last Name:ROL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:127 W 141ST ST APT 63
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-1843
Mailing Address - Country:US
Mailing Address - Phone:347-306-9641
Mailing Address - Fax:
Practice Address - Street 1:127 W 141ST ST APT 63
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-1843
Practice Address - Country:US
Practice Address - Phone:347-306-9641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111598-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker