Provider Demographics
NPI:1609964774
Name:ROLL, JOYCE LYNN (LCSW)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:LYNN
Last Name:ROLL
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 1:1025 NORTHERN BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1506
Mailing Address - Country:US
Mailing Address - Phone:516-671-5790
Mailing Address - Fax:516-627-6943
Practice Address - Street 1:1025 NORTHERN BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1506
Practice Address - Country:US
Practice Address - Phone:516-671-5790
Practice Address - Fax:516-627-6943
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR048845-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN8M421Medicare ID - Type UnspecifiedLCSW