Provider Demographics
NPI:1770372450
Name:ROBERTS, LATICIALENEE
Entity type:Individual
Prefix:MS
First Name:LATICIALENEE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 GLEN COVE AVE
Mailing Address - Street 2:
Mailing Address - City:SEA CLIFF
Mailing Address - State:NY
Mailing Address - Zip Code:11579-1816
Mailing Address - Country:US
Mailing Address - Phone:909-963-3277
Mailing Address - Fax:
Practice Address - Street 1:237 GLEN COVE AVE
Practice Address - Street 2:
Practice Address - City:SEA CLIFF
Practice Address - State:NY
Practice Address - Zip Code:11579-1816
Practice Address - Country:US
Practice Address - Phone:909-963-3277
Practice Address - Fax:909-963-3277
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist