Provider Demographics
NPI:1821206905
Name:ROBERTS, KRISTI S (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:S
Last Name:ROBERTS
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 1:112 S MAGNOLIA AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1920
Mailing Address - Country:US
Mailing Address - Phone:813-254-4434
Mailing Address - Fax:813-254-4434
Practice Address - Street 1:112 S MAGNOLIA AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1920
Practice Address - Country:US
Practice Address - Phone:813-254-4434
Practice Address - Fax:813-254-4434
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004253103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist