Provider Demographics
NPI:1568923928
Name:ROLAND, BRIANNA (LCSW)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:ROLAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2943
Mailing Address - Country:US
Mailing Address - Phone:859-816-5554
Mailing Address - Fax:
Practice Address - Street 1:200 HOME RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-1942
Practice Address - Country:US
Practice Address - Phone:859-261-8768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2539631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100596050Medicaid