Provider Demographics
NPI:1801099668
Name:ROLDAN, MILLICENT (SOCIAL WORKER)
Entity type:Individual
Prefix:MISS
First Name:MILLICENT
Middle Name:
Last Name:ROLDAN
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MSC APARTADO 189
Mailing Address - Street 2:P.O. BOX 7999
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-382-4973
Mailing Address - Fax:787-833-1371
Practice Address - Street 1:CENTRO SALUD MENTAL DE MAYAGUEZ
Practice Address - Street 2:410 AVE HOSTOS SUITE 7
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1522
Practice Address - Country:US
Practice Address - Phone:787-833-0663
Practice Address - Fax:787-833-1371
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR85331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical