Provider Demographics
NPI:1578701645
Name:ROBERTS, ROBERTA LEE (RN,BCBSN)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:LEE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RN,BCBSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 ASHFORD AVE
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-2001
Mailing Address - Country:US
Mailing Address - Phone:914-693-2341
Mailing Address - Fax:
Practice Address - Street 1:360 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1700
Practice Address - Country:US
Practice Address - Phone:914-682-1480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY289464163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health