Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 6134 | PR |
NPI | 1073106613 |
---|---|
Provider Name | Mrs. Grace Marie Rolon |
First Address | Toa Baja, PR 00949 |
Second Address | San Juan, PR 00926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2021 |
Last Update Date | 15/02/2021 |