Provider Demographics
NPI:1619222460
Name:ROLON, JOAN M (MA)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:ROLON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 CALLE BAHIA
Mailing Address - Street 2:URBANIZACION PUERTO NUEVO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-4046
Mailing Address - Country:US
Mailing Address - Phone:787-449-5508
Mailing Address - Fax:
Practice Address - Street 1:1133 AVE ROOSEVELT
Practice Address - Street 2:PUERTO NUEVO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-2908
Practice Address - Country:US
Practice Address - Phone:787-449-5508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4335103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling