Provider Demographics
NPI:1093193195
Name:ROORBACH, KRISTEN A (MT, PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:A
Last Name:ROORBACH
Suffix:
Gender:F
Credentials:MT, PHD
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:R
Other - Last Name:JAMISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 BOARS HEAD PL STE 240
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4628
Mailing Address - Country:US
Mailing Address - Phone:434-282-4088
Mailing Address - Fax:
Practice Address - Street 1:1 BOARS HEAD PL STE 240
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4628
Practice Address - Country:US
Practice Address - Phone:434-282-4088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor