Healthcare Provider Details

I. General information

NPI: 1700447729
Provider Name (Legal Business Name): ROSLYN MASS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ASMA BLVD STE 200
LAFAYETTE LA
70508-3868
US

IV. Provider business mailing address

615 W COTTON ST
VILLE PLATTE LA
70586-4407
US

V. Phone/Fax

Practice location:
  • Phone: 337-456-7880
  • Fax:
Mailing address:
  • Phone: 337-831-1365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: