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General NPI Number Information
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NPI Number | 1487315974
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Entity Type | Individual
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Provider Name | RAVEN ROLLE MSW
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Gender | Female
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Dates
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Enumeration Date | 01/06/2022
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Last Update Date | 01/06/2022
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Provider Practice Location Address
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Address Line | 8550 ULMERTON RD STE 145
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City | LARGO
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State | FL
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Zip | 33771-5357
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Country | US
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Telephone | 561-480-3436
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Fax |
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Provider Business Mailing Address
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Address Line | 2943 LAKESIDE COMMONS DR APT 103
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City | TAMPA
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State | FL
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Zip | 33613-5812
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Country | US
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Telephone | 561-480-3436
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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