Provider Demographics
NPI:1093199879
Name:ROBERTS, CLARA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CLARA
Middle Name:
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 1:500 WALTER ST NE STE 401
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2563
Mailing Address - Country:US
Mailing Address - Phone:505-727-5910
Mailing Address - Fax:505-727-9590
Practice Address - Street 1:500 WALTER ST NE STE 401
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2563
Practice Address - Country:US
Practice Address - Phone:505-727-5910
Practice Address - Fax:505-727-9590
Is Sole Proprietor?:No
Enumeration Date:2015-07-12
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X
NMPSY1699103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist