Provider Demographics
NPI:1528755139
Name:ROLLINS, IRA (MHC-LP)
Entity type:Individual
Prefix:MR
First Name:IRA
Middle Name:
Last Name:ROLLINS
Suffix:
Gender:M
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 STANHOPE ST APT 2L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-4313
Mailing Address - Country:US
Mailing Address - Phone:347-283-5456
Mailing Address - Fax:
Practice Address - Street 1:875 DEKALB AVE APT 1B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-6245
Practice Address - Country:US
Practice Address - Phone:917-260-9138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health