Provider Demographics
NPI:1609113109
Name:ROLLO, NICHOLE (LMFT)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:ROLLO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-2924
Mailing Address - Country:US
Mailing Address - Phone:626-808-7633
Mailing Address - Fax:
Practice Address - Street 1:572 E GREEN ST
Practice Address - Street 2:STE 304
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2045
Practice Address - Country:US
Practice Address - Phone:626-344-7764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52091106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist