Provider Demographics
NPI:1851609838
Name:ROLLE, ROBERT ANDREAS (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANDREAS
Last Name:ROLLE
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4502 SW FLORAL ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-7621
Mailing Address - Country:US
Mailing Address - Phone:772-293-9734
Mailing Address - Fax:863-223-2089
Practice Address - Street 1:4502 SW FLORAL ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-7621
Practice Address - Country:US
Practice Address - Phone:772-293-9734
Practice Address - Fax:863-223-2089
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst