Provider Demographics
NPI:1366948275
Name:LAM, ROLANDO MARTIN
Entity type:Individual
Prefix:MR
First Name:ROLANDO
Middle Name:MARTIN
Last Name:LAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7619 SONESTA SHORES DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-7913
Mailing Address - Country:US
Mailing Address - Phone:561-997-4831
Mailing Address - Fax:
Practice Address - Street 1:7619 SONESTA SHORES DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-7913
Practice Address - Country:US
Practice Address - Phone:561-997-4831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-01
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-25-78763103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst