Provider Demographics
NPI:1154469617
Name:ROBERTS, NANCY ELLEN (PSYD, PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ELLEN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PSYD, 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 693
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04429-0693
Mailing Address - Country:US
Mailing Address - Phone:207-852-7656
Mailing Address - Fax:
Practice Address - Street 1:5 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1932
Practice Address - Country:US
Practice Address - Phone:207-852-7656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS882103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM8057Medicare ID - Type UnspecifiedMEDICARE ID