Healthcare Provider Details

I. General information

NPI: 1578828885
Provider Name (Legal Business Name): ROGER SHERWOOD NOLAN JR. PSYD, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 MISSION ST STE 210
SAN MARINO CA
91108-1631
US

IV. Provider business mailing address

409 GARFIELD AVE
SOUTH PASADENA CA
91030-2208
US

V. Phone/Fax

Practice location:
  • Phone: 626-371-0048
  • Fax:
Mailing address:
  • Phone: 818-281-2523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT50759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: