Provider Demographics
NPI:1568824134
Name:ROLL, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:ROLL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 HIGHLAND AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2100
Mailing Address - Country:US
Mailing Address - Phone:978-825-6620
Mailing Address - Fax:978-825-6622
Practice Address - Street 1:55 HIGHLAND AVE STE 201
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2100
Practice Address - Country:US
Practice Address - Phone:978-825-6620
Practice Address - Fax:978-825-6622
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2818772084P0800X
MA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program