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General NPI Number Information
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NPI Number | 1770732372
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Entity Type | Individual
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Provider Name | ELISABETH ZAL ROLAND PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 09/18/2008
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Last Update Date | 09/09/2011
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Provider Practice Location Address
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Address Line | 1315 WALNUT STREET SUITE 1105
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City | PHILADELPHIA
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State | PA
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Zip | 19107
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Country | US
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Telephone | 215-550-1404
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Fax |
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Provider Business Mailing Address
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Address Line | 240 S 21ST ST
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City | PHILADELPHIA
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State | PA
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Zip | 19103-4819
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Country | US
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Telephone |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS017060
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License Number State | PA
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