Provider Demographics
NPI:1891186227
Name:ROLF, SHELLEY (LICSW)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:ROLF
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 CASTLE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1051
Mailing Address - Country:US
Mailing Address - Phone:413-429-6314
Mailing Address - Fax:
Practice Address - Street 1:192 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-9239
Practice Address - Country:US
Practice Address - Phone:802-447-1557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1063491041C0700X
VT089.00003851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical