Provider Demographics
NPI:1629365564
Name:NODERER, ROBERTA (LMFT)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:NODERER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1968 NE 7TH ST
Mailing Address - Street 2:102
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-3777
Mailing Address - Country:US
Mailing Address - Phone:954-540-8878
Mailing Address - Fax:
Practice Address - Street 1:370 CAMINO GARDENS BLVD
Practice Address - Street 2:113
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5816
Practice Address - Country:US
Practice Address - Phone:954-540-8878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2466106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist