Provider Demographics
NPI:1417206053
Name:ROBERTS, NICHOL KRISTEN
Entity Type:Individual
Prefix:
First Name:NICHOL
Middle Name:KRISTEN
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 1:360 REVERE BEACH BLVD
Mailing Address - Street 2:#316
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-4847
Mailing Address - Country:US
Mailing Address - Phone:978-335-1097
Mailing Address - Fax:
Practice Address - Street 1:360 REVERE BEACH BLVD
Practice Address - Street 2:#316
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-4847
Practice Address - Country:US
Practice Address - Phone:978-335-1097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist