Provider Demographics
NPI:1619289345
Name:ROBERTS, PENELOPE ANN (MS, CGC)
Entity Type:Individual
Prefix:MS
First Name:PENELOPE
Middle Name:ANN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:YAWKEY CENTER FOR OUTPATIENT CARE/SUITE 4F
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-643-4519
Mailing Address - Fax:617-724-9069
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:YAWKEY CENTER FOR OUTPATIENT CARE/SUITE 4F
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-2229
Practice Address - Fax:617-724-9069
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAGC054170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS