1073095964 NPI number — MS. ROBERTA JEAN OEHLEY LICSW

Table of content: MS. ROBERTA JEAN OEHLEY LICSW (NPI 1073095964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073095964 NPI number — MS. ROBERTA JEAN OEHLEY LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OEHLEY
Provider First Name:
ROBERTA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NELSON
Provider Other First Name:
ROBERTA
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073095964
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 BABEN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01749-3102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-212-5765
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 FARMERS WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01886-1306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-692-2708
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2018

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: 1041S0200X , with the licence number:  1032478 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1032478 . This is a "LICSW" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".