Provider Demographics
NPI:1073095964
Name:OEHLEY, ROBERTA JEAN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:JEAN
Last Name:OEHLEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:JEAN
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:1 BABEN RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-3102
Mailing Address - Country:US
Mailing Address - Phone:978-212-5765
Mailing Address - Fax:
Practice Address - Street 1:9 FARMERS WAY
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-1306
Practice Address - Country:US
Practice Address - Phone:978-692-2708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10324781041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1032478OtherLICSW