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General NPI Number Information
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NPI Number | 1871316653
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Entity Type | Individual
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Provider Name | LAINIE BETH ROLDAN RMHCI
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Gender | Female
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Dates
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Enumeration Date | 11/01/2024
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 1903 S CONGRESS AVE STE 300
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-6558
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Country | US
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Telephone | 954-719-4613
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Fax |
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Provider Business Mailing Address
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Address Line | 11635 WATERBEND CT
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City | WELLINGTON
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State | FL
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Zip | 33414-8850
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Country | US
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Telephone | 917-359-6492
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | IMH26140
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License Number State | FL
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