Provider Demographics
NPI:1639710221
Name:ROLL, STEVEN WILLIAM
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:WILLIAM
Last Name:ROLL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CANALS END RD STE 201B
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-4821
Mailing Address - Country:US
Mailing Address - Phone:215-823-4590
Mailing Address - Fax:
Practice Address - Street 1:2 CANALS END RD STE 201B
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-4821
Practice Address - Country:US
Practice Address - Phone:215-823-4590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00295100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health