Provider Demographics
NPI:1902906449
Name:ROLFE, WILLIAM D
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:D
Last Name:ROLFE
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:
Other - Last Name:ROLFE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:612 N SEPULVEDA BLVD STE 18
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-2176
Mailing Address - Country:US
Mailing Address - Phone:310-824-1560
Mailing Address - Fax:
Practice Address - Street 1:612 N SEPULVEDA BLVD STE 18
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-2176
Practice Address - Country:US
Practice Address - Phone:310-824-1560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20499103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical