Provider Demographics
NPI:1912527458
Name:SOLOMON, ROGER M (PHD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:M
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 9TH ST N APT 404
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1958
Mailing Address - Country:US
Mailing Address - Phone:716-570-3683
Mailing Address - Fax:
Practice Address - Street 1:4001 9TH ST N APT 404
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1958
Practice Address - Country:US
Practice Address - Phone:716-570-3683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6766-PY-PR103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist