Healthcare Provider Details

I. General information

NPI: 1639682412
Provider Name (Legal Business Name): KASSANDRA ROLDAN MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24481 DETROIT RD
WESTLAKE OH
44145-1580
US

IV. Provider business mailing address

14609 TERMINAL AVE
CLEVELAND OH
44135-2039
US

V. Phone/Fax

Practice location:
  • Phone: 440-310-6361
  • Fax:
Mailing address:
  • Phone: 216-631-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.1802743
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: