Healthcare Provider Details

I. General information

NPI: 1194842088
Provider Name (Legal Business Name): ARLYN JANE ROFFMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 PAYSON RD
BELMONT MA
02478-2834
US

IV. Provider business mailing address

230 PAYSON RD
BELMONT MA
02478-2834
US

V. Phone/Fax

Practice location:
  • Phone: 617-484-0955
  • Fax:
Mailing address:
  • Phone: 617-484-0955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3992
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: