Provider Demographics
NPI:1841762606
Name:ROBERTS, TJURRA JAMAIYA
Entity Type:Individual
Prefix:
First Name:TJURRA
Middle Name:JAMAIYA
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MIDDLESEX ESSEX TPKE STE 102
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-2033
Mailing Address - Country:US
Mailing Address - Phone:732-655-6339
Mailing Address - Fax:
Practice Address - Street 1:200 MIDDLESEX ESSEX TPKE STE 102
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-2033
Practice Address - Country:US
Practice Address - Phone:732-655-6339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00321600101YM0800X
101YM0800X
NJ37PC00699900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health