Provider Demographics
NPI:1912786161
Name:ROLLISON, PETRESA (LCSW)
Entity Type:Individual
Prefix:
First Name:PETRESA
Middle Name:
Last Name:ROLLISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 KEYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-5916
Mailing Address - Country:US
Mailing Address - Phone:724-953-1822
Mailing Address - Fax:
Practice Address - Street 1:2858 FREEPORT RD STE A
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-1970
Practice Address - Country:US
Practice Address - Phone:724-953-1822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0232781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical