Provider Demographics
NPI:1659436202
Name:WARREN, ROBERTA F (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:F
Last Name:WARREN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BEAUMONT DR
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3402
Mailing Address - Country:US
Mailing Address - Phone:631-491-3078
Mailing Address - Fax:631-491-3078
Practice Address - Street 1:14 BEAUMONT DR
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3402
Practice Address - Country:US
Practice Address - Phone:631-491-3078
Practice Address - Fax:631-491-3078
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7456103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical