Doctor Name: | RYAN ROLESON |
NPI Number: | 1003057886 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | D6038966 |
Business Practice Address: | 4368 Lincoln Ave Oakland, CA - 946022529 |
Business Phone Number: | 5105313111 |
Business Fax Number: | |
Mailing Address: | 2511 Parker St Apt 205, BERKELEY |
State: | CA |
Postal Code: | 947042972 |
Phone Number: | 8583829384 |
Fax Number: | |
NPI Enumeration Date: | 03/09/2009 |
NPI Last Update Date: | 03/09/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | D6038966 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |