Provider Demographics
NPI:1659006153
Name:ROBERTS, PATRICE (BCBA)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 MONROE DR
Mailing Address - Street 2:
Mailing Address - City:STEWARTSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08886-2633
Mailing Address - Country:US
Mailing Address - Phone:973-800-3733
Mailing Address - Fax:
Practice Address - Street 1:331 HOOPER ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-2591
Practice Address - Country:US
Practice Address - Phone:973-800-3733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-22-59747103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-22-59747OtherBEHAVIOR ANALYST