Healthcare Provider Details

I. General information

NPI: 1083030845
Provider Name (Legal Business Name): TARA LYNN ROLAND M.A., L.B.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3428 BRODHEAD RD
MONACA PA
15061-3132
US

IV. Provider business mailing address

3428 BRODHEAD RD
MONACA PA
15061-3132
US

V. Phone/Fax

Practice location:
  • Phone: 724-728-6670
  • Fax: 724-728-5570
Mailing address:
  • Phone: 724-728-6670
  • Fax: 724-728-5570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberBH000254
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: