Provider Demographics
NPI:1609365279
Name:ROBERTS, PATRICIA (LADC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1089 PARK ST
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:MA
Mailing Address - Zip Code:01069-1745
Mailing Address - Country:US
Mailing Address - Phone:774-232-8609
Mailing Address - Fax:
Practice Address - Street 1:1089 PARK ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1745
Practice Address - Country:US
Practice Address - Phone:774-232-8609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10380101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)