Provider Demographics
NPI:1568246916
Name:ROBERTS, HALEY RAE
Entity Type:Individual
Prefix:MISS
First Name:HALEY
Middle Name:RAE
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 1:8922 CUMING ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2732
Mailing Address - Country:US
Mailing Address - Phone:402-926-4373
Mailing Address - Fax:402-926-3898
Practice Address - Street 1:2320 S 48TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5515
Practice Address - Country:US
Practice Address - Phone:402-218-4667
Practice Address - Fax:402-926-3898
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NERBT-23-290047106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician