Provider Demographics
NPI:1437297983
Name:TAYLOR, ROBERTA K (RNCS)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:K
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RNCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 BISHOPS FOREST DR
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-8808
Mailing Address - Country:US
Mailing Address - Phone:781-894-5640
Mailing Address - Fax:
Practice Address - Street 1:1 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-1711
Practice Address - Country:US
Practice Address - Phone:781-330-3855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA116369103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0022133OtherANCC CERTIFICATION
MAPN0039OtherBCBS PROVIDER #
MA116369OtherNURSING LICENSE
MA116369OtherNURSING LICENSE