Provider Demographics
NPI:1083030845
Name:ROLAND, TARA LYNN (MA, LBS)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:LYNN
Last Name:ROLAND
Suffix:
Gender:F
Credentials:MA, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3428 BRODHEAD RD
Mailing Address - Street 2:
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-3132
Mailing Address - Country:US
Mailing Address - Phone:724-728-6670
Mailing Address - Fax:724-728-5570
Practice Address - Street 1:3428 BRODHEAD RD
Practice Address - Street 2:
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-3132
Practice Address - Country:US
Practice Address - Phone:724-728-6670
Practice Address - Fax:724-728-5570
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000254251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health