Provider Demographics
NPI:1760519599
Name:ROBERTS, AMBROSIA D (BS MHP)
Entity Type:Individual
Prefix:
First Name:AMBROSIA
Middle Name:D
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:BS MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 WEST 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:METROPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62960
Mailing Address - Country:US
Mailing Address - Phone:618-524-9368
Mailing Address - Fax:618-524-9551
Practice Address - Street 1:206 WEST 5TH STREET
Practice Address - Street 2:
Practice Address - City:METROPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62960
Practice Address - Country:US
Practice Address - Phone:618-524-9368
Practice Address - Fax:618-524-9551
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health