Healthcare Provider Details

I. General information

NPI: 1447155726
Provider Name (Legal Business Name): THERESA ROLLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOSTON MEDICAL CTR PL STE 1
BOSTON MA
02118-2999
US

IV. Provider business mailing address

1 BOSTON MEDICAL CTR PL STE 1
BOSTON MA
02118-2999
US

V. Phone/Fax

Practice location:
  • Phone: 617-866-0537
  • Fax:
Mailing address:
  • Phone: 617-866-0537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: