Provider Demographics
NPI:1558908137
Name:WATLEY, ROLANDO (LPC)
Entity type:Individual
Prefix:
First Name:ROLANDO
Middle Name:
Last Name:WATLEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 RACHEL TER APT 9
Mailing Address - Street 2:
Mailing Address - City:PINE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07058-9301
Mailing Address - Country:US
Mailing Address - Phone:646-301-8760
Mailing Address - Fax:847-859-5885
Practice Address - Street 1:1300 RACHEL TER APT 9
Practice Address - Street 2:
Practice Address - City:PINE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07058-9301
Practice Address - Country:US
Practice Address - Phone:646-301-8760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-03
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00496900101YM0800X
NJ37PC00958900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health