Provider Demographics
NPI:1336339027
Name:ROLLINS-GARCIA, LISA D (PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:D
Last Name:ROLLINS-GARCIA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11954 BANYAN ST
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2106
Mailing Address - Country:US
Mailing Address - Phone:561-691-0975
Mailing Address - Fax:
Practice Address - Street 1:12300 ALTERNATE A1A
Practice Address - Street 2:SUITE 108
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2205
Practice Address - Country:US
Practice Address - Phone:561-625-9464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-28
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5334103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59838Medicare PIN