Provider Demographics
NPI:1790175305
Name:BURTON-ROBERTSON, ROSLYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROSLYN
Middle Name:
Last Name:BURTON-ROBERTSON
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 1:40 PERSHING AVE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-3326
Mailing Address - Country:US
Mailing Address - Phone:203-550-6350
Mailing Address - Fax:
Practice Address - Street 1:733 SUMMER ST
Practice Address - Street 2:SUITE 104
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-1081
Practice Address - Country:US
Practice Address - Phone:203-550-6350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral