Provider Demographics
NPI:1770596561
Name:ROBERTS, THERESA E (MS, LMHC)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:E
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 DEERFIELD DRIVE
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450-1567
Mailing Address - Country:US
Mailing Address - Phone:978-448-5688
Mailing Address - Fax:
Practice Address - Street 1:71 MAIN ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:WESTMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01473-1472
Practice Address - Country:US
Practice Address - Phone:978-302-5712
Practice Address - Fax:978-272-1395
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6019101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health