Provider Demographics
NPI:1750682332
Name:ROBERTS, H EDWARD JR (MS, LADC)
Entity Type:Individual
Prefix:
First Name:H EDWARD
Middle Name:
Last Name:ROBERTS
Suffix:JR
Gender:M
Credentials:MS, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PEARL ST STE 208
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3648
Mailing Address - Country:US
Mailing Address - Phone:802-288-9292
Mailing Address - Fax:
Practice Address - Street 1:11 PEARL ST STE 208
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-3648
Practice Address - Country:US
Practice Address - Phone:802-288-9292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000209101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)