Provider Demographics
NPI:1184013427
Name:ROBERTS, ELIZABETH VAIL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:VAIL
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:WEST STOCKBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01266-0306
Mailing Address - Country:US
Mailing Address - Phone:413-274-2393
Mailing Address - Fax:413-353-5006
Practice Address - Street 1:69 CHURCH ST STE 4
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240-2540
Practice Address - Country:US
Practice Address - Phone:413-274-2393
Practice Address - Fax:413-353-5006
Is Sole Proprietor?:No
Enumeration Date:2015-01-09
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012490103G00000X
NJ3978103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist