MEDICARE: DR. ROSLYN BURTON-ROBERTSON PHD

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	101YP1600X	Pastoral Counselor

General Provider Information

NPI Number	:	1790175305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSLYN BURTON-ROBERTSON PHD

Provider Business Mailing Address
First Line	:	40 PERSHING AVE
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06905-3326
Country	:	US
Telephone Number	:	203-550-6350
Fax Number	:

Provider Business Practice Location Address
First Line	:	733 SUMMER ST
Second Line	:	SUITE 104
City	:	STAMFORD
State	:	CT
Zip	:	06901-1081
Country	:	US
Telephone Number	:	203-550-6350
Fax Number	:

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

Provider Enumeration Date	:	02/03/2015
Last Update Date	:	02/03/2015

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