Provider Demographics
NPI:1942308838
Name:OLIVARDIA, ROBERTO (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:OLIVARDIA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 MASSACHUSETTS AVE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-5000
Mailing Address - Country:US
Mailing Address - Phone:781-648-4684
Mailing Address - Fax:
Practice Address - Street 1:661 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-5000
Practice Address - Country:US
Practice Address - Phone:781-648-4684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7951103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW06121OtherBCBS
MAW06121OtherBCBS