Provider Demographics
NPI:1356482327
Name:ROBERTS, LYNN (PSYD)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 RIDGEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-3334
Mailing Address - Country:US
Mailing Address - Phone:860-869-3246
Mailing Address - Fax:
Practice Address - Street 1:30 LAFAYETTE SQ STE 1B
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4554
Practice Address - Country:US
Practice Address - Phone:860-869-3246
Practice Address - Fax:860-871-4917
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2608103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT221160OtherCIGNA
CT060002608CT02OtherBLUE CROSS PROVIDER NUMBE
CT198353OtherMANAGED HEALTH NETWORK