Provider Demographics
NPI:1417350034
Name:ROBERTS, LAURIE (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 TEMPLETON CT
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3950
Mailing Address - Country:US
Mailing Address - Phone:860-930-7840
Mailing Address - Fax:
Practice Address - Street 1:9 TEMPLETON CT
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3950
Practice Address - Country:US
Practice Address - Phone:860-930-7840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-28
Last Update Date:2014-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001493101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional