Provider Demographics
NPI:1578828885
Name:NOLAN, ROGER SHERWOOD JR (MA, LMFT)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:SHERWOOD
Last Name:NOLAN
Suffix:JR
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 FREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-2529
Mailing Address - Country:US
Mailing Address - Phone:626-371-0048
Mailing Address - Fax:
Practice Address - Street 1:725 FREMONT AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-2529
Practice Address - Country:US
Practice Address - Phone:626-371-0048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC50759106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist