Provider Demographics
NPI:1942405964
Name:ROBERTS, BRETT (MSED)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4923 ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:EAST PALESTINE
Mailing Address - State:OH
Mailing Address - Zip Code:44413-8769
Mailing Address - Country:US
Mailing Address - Phone:330-501-8200
Mailing Address - Fax:330-426-9415
Practice Address - Street 1:4923 ADAMS RD
Practice Address - Street 2:
Practice Address - City:EAST PALESTINE
Practice Address - State:OH
Practice Address - Zip Code:44413-8769
Practice Address - Country:US
Practice Address - Phone:330-501-8200
Practice Address - Fax:330-426-9415
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 0001619101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional