Provider Demographics
NPI:1255848586
Name:THERESA E ROBERTS, MS, LMHC, LLC
Entity Type:Organization
Organization Name:THERESA E ROBERTS, MS, LMHC, LLC
Other - Org Name:THERESA E ROBERTS, MS, LMHC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC
Authorized Official - Phone:978-302-5712
Mailing Address - Street 1:11 TRILLIUM CT
Mailing Address - Street 2:
Mailing Address - City:LUNENBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01462-4401
Mailing Address - Country:US
Mailing Address - Phone:978-302-5712
Mailing Address - Fax:978-582-1675
Practice Address - Street 1:71 MAIN ST STE 2-A
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01473-1472
Practice Address - Country:US
Practice Address - Phone:978-302-5712
Practice Address - Fax:978-582-1675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6019101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty