Provider Demographics
NPI:1316155435
Name:ROLLINS, JEANNE LIGHTBODY (MS)
Entity type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:LIGHTBODY
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ELDRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-2442
Mailing Address - Country:US
Mailing Address - Phone:914-967-7951
Mailing Address - Fax:
Practice Address - Street 1:1600 HARRISON AVE
Practice Address - Street 2:SUITE 100, ROCKLEDGE BUILDING
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3145
Practice Address - Country:US
Practice Address - Phone:914-967-7951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000494-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist