Provider Demographics
NPI:1033315882
Name:ROBERTS, PRISCILLA CUMMINGS (PHD)
Entity Type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:CUMMINGS
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28279
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87592-8279
Mailing Address - Country:US
Mailing Address - Phone:505-983-0586
Mailing Address - Fax:505-424-0949
Practice Address - Street 1:4435 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-2894
Practice Address - Country:US
Practice Address - Phone:505-983-0586
Practice Address - Fax:505-424-0949
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM668103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist