MEDICARE: JOAN M ROLON M.A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	4335	PR

General Provider Information

NPI Number	:	1619222460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN M ROLON M.A

Provider Business Mailing Address
First Line	:	1145 CALLE BAHIA
Second Line	:	URBANIZACION PUERTO NUEVO
City	:	SAN JUAN
State	:	PR
Zip	:	00920-4046
Country	:	US
Telephone Number	:	787-449-5508
Fax Number	:

Provider Business Practice Location Address
First Line	:	1133 AVE ROOSEVELT
Second Line	:	PUERTO NUEVO
City	:	SAN JUAN
State	:	PR
Zip	:	00920-2908
Country	:	US
Telephone Number	:	787-449-5508
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2012
Last Update Date	:	07/18/2012

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