Provider Demographics
NPI:1619992989
Name:PALEY, ROBERTA L (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:L
Last Name:PALEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 PARK PL
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-2821
Mailing Address - Country:US
Mailing Address - Phone:718-336-0641
Mailing Address - Fax:
Practice Address - Street 1:14 PARK PL
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-2821
Practice Address - Country:US
Practice Address - Phone:802-275-7492
Practice Address - Fax:802-579-1509
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.00883611041C0700X
NYR043140-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN2J093Medicare ID - Type Unspecified