Roll-Mederos, Jan
Roll-Mederos, Jan is an sole proprietor health care provider with primary practice located at 86 Forest Hills St , Jamaica Plain MA 02130-2935. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Roll-Mederos, Jan can be contacted via phone (617) 524-2415.Contact Information
Primary practice address
86 Forest Hills St
Jamaica Plain MA 02130-2935
Phone: (617) 524-2415
Fax: (617) 524-7717
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 105053 | Massachusetts |
Profile Details
| NPI number | 1750341996 |
|---|---|
| LBN Legal business name | Roll-Mederos, Jan |
| Credentials | M.S.W. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Mar 23rd, 2006 |
| Last updated | Dec 5th, 2012 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1750341996 | NPPES |
| Massachusetts | MEDICAID | 1852094 | |
| Massachusetts | MEDICAID | 1891260 | |
| Massachusetts | Other | P04867 | |
| Massachusetts | Other | 110286000 | |
| Massachusetts | Other | 1019670 |
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