Provider Demographics
NPI:1639266398
Name:ROLANDO A. LARICE PC
Entity Type:Organization
Organization Name:ROLANDO A. LARICE PC
Other - Org Name:ROLANDO LARICE AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:LARICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-434-9181
Mailing Address - Street 1:140 CHESTERFIELD COMMONS RD E
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1440
Mailing Address - Country:US
Mailing Address - Phone:314-434-9181
Mailing Address - Fax:636-536-9588
Practice Address - Street 1:140 CHESTERFIELD COMMONS RD E
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1440
Practice Address - Country:US
Practice Address - Phone:314-440-4709
Practice Address - Fax:636-536-9588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1165172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty