Provider Demographics
NPI:1770328817
Name:EMILY ROLL LISW-S LLC
Entity type:Organization
Organization Name:EMILY ROLL LISW-S LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLL
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:440-263-1279
Mailing Address - Street 1:14618 RAINBOW AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-2221
Mailing Address - Country:US
Mailing Address - Phone:440-263-1279
Mailing Address - Fax:
Practice Address - Street 1:3500 LORAIN AVE STE 407
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-3726
Practice Address - Country:US
Practice Address - Phone:216-200-8543
Practice Address - Fax:216-744-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-29
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty