Healthcare Provider Details

I. General information

NPI: 1326375197
Provider Name (Legal Business Name): MELISSA STEPHANIE ROFFMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2009
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 W MONROE ST SUITE 200
JACKSONVILLE FL
32204-1177
US

IV. Provider business mailing address

915 W MONROE ST SUITE 200
JACKSONVILLE FL
32204-1177
US

V. Phone/Fax

Practice location:
  • Phone: 904-384-2240
  • Fax:
Mailing address:
  • Phone: 904-384-2240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY8013
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: