Healthcare Provider Details

I. General information

NPI: 1306057534
Provider Name (Legal Business Name): CAROLINE GRIESER ROLENS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34830 BOGART DR
SPRINGVILLE CA
93265-9164
US

IV. Provider business mailing address

34830 BOGART DR
SPRINGVILLE CA
93265-9164
US

V. Phone/Fax

Practice location:
  • Phone: 559-539-6426
  • Fax: 559-539-6426
Mailing address:
  • Phone: 559-539-6426
  • Fax: 559-539-6426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY3950
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: