Provider Demographics
NPI:1184711350
Name:VERFAILLIE, ROLAND B (PHD, LMHC)
Entity type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:B
Last Name:VERFAILLIE
Suffix:
Gender:
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5084 SE PINE KNOLL WAY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-6993
Mailing Address - Country:US
Mailing Address - Phone:772-631-4129
Mailing Address - Fax:
Practice Address - Street 1:8241 S US 1
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952
Practice Address - Country:US
Practice Address - Phone:772-878-9368
Practice Address - Fax:772-878-9378
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2480101YM0800X
FLMH 24801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical