Provider Demographics
NPI:1467060590
Name:HUBER, ROBERTA LYNNE (MA)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:LYNNE
Last Name:HUBER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:LYNNE
Other - Last Name:LARKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:355 QUARTERMASTER CT
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3670
Practice Address - Country:US
Practice Address - Phone:812-258-9802
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-20-127175106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician