MEDICARE: ROBERTA GERLING LLC

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	103TP2701X	Group Psychotherapy Psychologist	LP5808	MN

General Provider Information

NPI Number	:	1548790215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERTA GERLING LLC

Provider Business Mailing Address
First Line	:	16204 HIGHWAY 7
Second Line	:
City	:	MINNETONKA
State	:	MN
Zip	:	55345-3405
Country	:	US
Telephone Number	:	952-217-3412
Fax Number	:	952-934-3010

Provider Business Practice Location Address
First Line	:	6400 FLYING CLOUD DR STE 180
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-3337
Country	:	US
Telephone Number	:	952-217-3412
Fax Number	:	952-600-4136

Authorized Official
Title or Position	:	PRESIDENT AND LICENSED PSYCHOLOGIST
Name	:	DR. ROBERTA LYNN GERLING
Credential	:	PSYD, LP
Telephone Number	:	952-217-3412

Provider Enumeration Date	:	06/15/2017
Last Update Date	:	11/24/2024

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