MEDICARE: DR. MARION ROBERTS PH.D.

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	MH0005637	FL

General Provider Information

NPI Number	:	1134363765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARION ROBERTS PH.D.

Provider Business Mailing Address
First Line	:	3767 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4048
Country	:	US
Telephone Number	:	561-968-5255
Fax Number	:

Provider Business Practice Location Address
First Line	:	3767 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4048
Country	:	US
Telephone Number	:	561-968-5255
Fax Number	:

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

Provider Enumeration Date	:	04/27/2009
Last Update Date	:	04/27/2009

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