MEDICARE: DR. CATHY LAURA ROBERTS PSY.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	103TC0700X	Clinical Psychologist	PY 7411	FL

General Provider Information

NPI Number	:	1184747149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CATHY LAURA ROBERTS PSY.D.

Provider Business Mailing Address
First Line	:	4301 S FLAMINGO RD
Second Line	:	SUITE 103-128
City	:	DAVIE
State	:	FL
Zip	:	33330-1902
Country	:	US
Telephone Number	:	954-461-5690
Fax Number	:

Provider Business Practice Location Address
First Line	:	7376 NW 5TH ST
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33317-1605
Country	:	US
Telephone Number	:	954-461-5690
Fax Number	:

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

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	07/08/2007

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