Provider Demographics
NPI:1619130846
Name:ROBERTS, BEVERLY JEAN
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:JEAN
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 1:1800 MERCY DR STE 302
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-5648
Mailing Address - Country:US
Mailing Address - Phone:407-875-3700
Mailing Address - Fax:407-522-4671
Practice Address - Street 1:1800 MERCY DR STE 302
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-5648
Practice Address - Country:US
Practice Address - Phone:407-875-3700
Practice Address - Fax:407-522-4671
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health