Provider Demographics
NPI:1134244171
Name:ROBERTS, GLORIA JEAN (LMHC,LMFT)
Entity type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:JEAN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LMHC,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 WRIGHT ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3539
Mailing Address - Country:US
Mailing Address - Phone:781-438-0727
Mailing Address - Fax:
Practice Address - Street 1:61 WRIGHT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3539
Practice Address - Country:US
Practice Address - Phone:781-438-0727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2010101YM0800X
MA680103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM0268OtherBCBS PROVIDER #