Provider Demographics
NPI:1710490768
Name:URIBE, ROBERTO ALEJANDRO (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:ALEJANDRO
Last Name:URIBE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 LYNNEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-1906
Mailing Address - Country:US
Mailing Address - Phone:267-252-9230
Mailing Address - Fax:
Practice Address - Street 1:300 CREEK VIEW RD STE 101
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-8547
Practice Address - Country:US
Practice Address - Phone:302-524-0814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-13
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0001097103TC0700X, 103TC2200X
PAPS019606103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty