Provider Demographics
NPI:1972779627
Name:ROLLER, LORRIE (MSW)
Entity type:Individual
Prefix:
First Name:LORRIE
Middle Name:
Last Name:ROLLER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2453 ATWOOD AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-5661
Mailing Address - Country:US
Mailing Address - Phone:608-242-8780
Mailing Address - Fax:608-242-8790
Practice Address - Street 1:2453 ATWOOD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5661
Practice Address - Country:US
Practice Address - Phone:608-242-8780
Practice Address - Fax:608-242-8790
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI67201231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical