Provider Demographics
NPI:1841393238
Name:ROBERTS, RICHARD JONATHAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JONATHAN
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:601 HIGHWAY 6 W
Mailing Address - Street 2:DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-2208
Mailing Address - Country:US
Mailing Address - Phone:319-338-0581
Mailing Address - Fax:319-339-7068
Practice Address - Street 1:601 HIGHWAY 6 W
Practice Address - Street 2:DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-2208
Practice Address - Country:US
Practice Address - Phone:319-338-0581
Practice Address - Fax:319-339-7068
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00504103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical