MEDICARE: MRS. JEANNE LIGHTBODY ROLLINS M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	000494-1	NY

General Provider Information

NPI Number	:	1316155435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEANNE LIGHTBODY ROLLINS M.S.

Provider Business Mailing Address
First Line	:	8 ELDRIDGE PL
Second Line	:
City	:	RYE
State	:	NY
Zip	:	10580-2442
Country	:	US
Telephone Number	:	914-967-7951
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 HARRISON AVE
Second Line	:	SUITE 100, ROCKLEDGE BUILDING
City	:	MAMARONECK
State	:	NY
Zip	:	10543-3145
Country	:	US
Telephone Number	:	914-967-7951
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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