Provider Demographics
NPI:1003903006
Name:ROBERTS, SCOTT B (MA)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:B
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-1349
Mailing Address - Country:US
Mailing Address - Phone:724-852-3063
Mailing Address - Fax:724-852-3063
Practice Address - Street 1:79 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-1349
Practice Address - Country:US
Practice Address - Phone:724-852-3063
Practice Address - Fax:724-852-3063
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-005683-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA019629Medicare ID - Type Unspecified