Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PY7240 | FL |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PY7240 | FL |
Y | 103G00000X | Clinical Psychologist | PY7240 | FL |
Y | 103TC0700X | Clinical Psychologist | PY7240 | FL |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PY7240 | FL |
N | 103TP2701X | Group Psychotherapist | PY7240 | FL |
NPI | 1033357785 |
---|---|
Provider Name | Dr. Jacqueline S Roller |
First Address | Sarasota, FL 34237-5351 |
Second Address | Sarasota, FL 34237-5351 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2009 |
Last Update Date | 18/11/2015 |