Provider Demographics
NPI:1194473587
Name:ROBERTS, SYDNEY M
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:M
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6830 BRANDT PIKE APT A
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-3380
Mailing Address - Country:US
Mailing Address - Phone:937-965-2935
Mailing Address - Fax:
Practice Address - Street 1:6830 BRANDT PIKE APT A
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-3380
Practice Address - Country:US
Practice Address - Phone:937-965-2935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH179857101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)