Provider Demographics
NPI:1538644711
Name:ROLON, YARITZA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:YARITZA
Middle Name:
Last Name:ROLON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MRS
Other - First Name:YARITZA
Other - Middle Name:
Other - Last Name:ROLON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:6201 ARTILLERY AVE
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:WI
Mailing Address - Zip Code:54656-8316
Mailing Address - Country:US
Mailing Address - Phone:787-667-0420
Mailing Address - Fax:
Practice Address - Street 1:6201 ARTILLERY AVE
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:WI
Practice Address - Zip Code:54656-8316
Practice Address - Country:US
Practice Address - Phone:787-667-0420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4617027OtherDRIVERS LICENSE