1043384787 NPI number — MS. DEBRA L ROBERTS LADC, LICSW

Table of content: MS. DEBRA L ROBERTS LADC, LICSW (NPI 1043384787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043384787 NPI number — MS. DEBRA L ROBERTS LADC, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTS
Provider First Name:
DEBRA
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LADC, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROBERTS
Provider Other First Name:
DEBRA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043384787
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
128 MERCHANTS ROW
Provider Second Line Business Mailing Address:
SUITE 611- 612
Provider Business Mailing Address City Name:
RUTLAND
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05701-5911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-786-8008
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
128 MERCHANTS ROW
Provider Second Line Business Practice Location Address:
SUITE 611- 612
Provider Business Practice Location Address City Name:
RUTLAND
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05701-5911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-786-8008
Provider Business Practice Location Address Fax Number:
802-786-8008
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  000207 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 089-0000521 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 364282 . This is a "MVP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 2172180 . This is a "CIGNA" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 59865 . This is a "BLUE CROSS,BLUE SHIELD" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 115219 . This is a "TEAMSTERS BEHAV. HEALTH" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1010145 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 589706000 . This is a "MAGELLAN" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com