MEDICARE: MR. DARRY A. ROBERTS LMHC, NCC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	000715	NY

General Provider Information

NPI Number	:	1013021260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DARRY A. ROBERTS LMHC, NCC.

Provider Business Mailing Address
First Line	:	59 RAM RD
Second Line	:
City	:	MORRISONVILLE
State	:	NY
Zip	:	12962-9669
Country	:	US
Telephone Number	:	518-293-1279
Fax Number	:	518-293-1279

Provider Business Practice Location Address
First Line	:	59 RAM RD
Second Line	:
City	:	MORRISONVILLE
State	:	NY
Zip	:	12962-9669
Country	:	US
Telephone Number	:	518-293-1279
Fax Number	:	518-293-1279

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	07/08/2007

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