Provider Demographics
NPI:1942382262
Name:ROLLER, WILLIAM LLOYD (MFT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LLOYD
Last Name:ROLLER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:MR
Other - First Name:BILL
Other - Middle Name:LLOYD
Other - Last Name:ROLLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:1104 SHATTUCK AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-2610
Mailing Address - Country:US
Mailing Address - Phone:510-525-9215
Mailing Address - Fax:510-525-4651
Practice Address - Street 1:1104 SHATTUCK AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-2610
Practice Address - Country:US
Practice Address - Phone:510-525-9215
Practice Address - Fax:510-525-4651
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM14245106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist