Provider Demographics
NPI:1013066075
Name:ROBERTS, JANICE SHIRLEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:SHIRLEY
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:SHIRLEY
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2624 PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1906
Mailing Address - Country:US
Mailing Address - Phone:419-885-1156
Mailing Address - Fax:419-885-1156
Practice Address - Street 1:2624 PHEASANT LN
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1906
Practice Address - Country:US
Practice Address - Phone:419-885-1156
Practice Address - Fax:419-885-1156
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2634103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH22000000348931OtherANTHEM BCBS
OH276396OtherABDA DIS
OH1281534OtherCIGNA
OH0160758Medicaid
OHROCP11071Medicare ID - Type Unspecified