Provider Demographics
NPI:1114576667
Name:ROBERTS, AHMED OMAR (CDCA)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:OMAR
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20710 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7062
Mailing Address - Country:US
Mailing Address - Phone:216-357-0683
Mailing Address - Fax:216-591-1243
Practice Address - Street 1:20710 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-7062
Practice Address - Country:US
Practice Address - Phone:216-357-0683
Practice Address - Fax:216-591-1243
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-07
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No251S00000XAgenciesCommunity/Behavioral Health