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Individual
MS. JAN ROLL-MEDEROS
Active
Individual
MS. JAN ROLL-MEDEROS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.W.
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
105053
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1019670
NEIGHBORHOOD HEALTH PLAN
MA
01
—
110286000
MAGELLAN BEHAVIORAL HEALT
MA
05
—
1852094
—
MA
05
—
1891260
—
MA
01
—
P04867
BLUE CROSS BLUE SHIELD MA
MA
Enumeration date
03/23/2006
Last updated
12/05/2012
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