Provider Demographics
NPI:1558947887
Name:ROBERTS, ALEX (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-468-0300
Mailing Address - Fax:239-343-4257
Practice Address - Street 1:3501 HEALTH CENTER BLVD STE 2190
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:34135-8133
Practice Address - Country:US
Practice Address - Phone:239-468-0300
Practice Address - Fax:239-343-4257
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06419103T00000X
FLPY11278103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112105100Medicaid