Provider Demographics
NPI:1295220051
Name:DUSSAN ROLDAN, GENEVIEVE ADRIA (BCBA)
Entity type:Individual
Prefix:MRS
First Name:GENEVIEVE
Middle Name:ADRIA
Last Name:DUSSAN ROLDAN
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:MISS
Other - First Name:GENEVIEVE
Other - Middle Name:ADRIA
Other - Last Name:TORRICELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:224 E 135TH ST APT 1905
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-6489
Mailing Address - Country:US
Mailing Address - Phone:917-715-7931
Mailing Address - Fax:
Practice Address - Street 1:224 E 135TH ST APT 1905
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-6489
Practice Address - Country:US
Practice Address - Phone:917-715-7931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-25-79656103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBACB1036398OtherBACB ID