Provider Demographics
NPI:1689657348
Name:ROEBUCK, R ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:R
Middle Name:ELIZABETH
Last Name:ROEBUCK
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 1:36 OAK CLIFF RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460-2325
Mailing Address - Country:US
Mailing Address - Phone:617-965-0806
Mailing Address - Fax:
Practice Address - Street 1:36 OAK CLIFF RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02460-2325
Practice Address - Country:US
Practice Address - Phone:617-965-0806
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2965103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling