Healthcare Provider Details

I. General information

NPI: 1497959811
Provider Name (Legal Business Name): DILICE G ROBERTSON APRN,PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 OXFORD RD UNIT L
OXFORD CT
06478-1900
US

IV. Provider business mailing address

71 OXFORD RD UNIT L
OXFORD CT
06478-1900
US

V. Phone/Fax

Practice location:
  • Phone: 203-463-4555
  • Fax: 203-517-0058
Mailing address:
  • Phone: 203-463-4555
  • Fax: 203-517-0058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number003973
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code364SP0810X
TaxonomyChild & Family Psychiatric/Mental Health Clinical Nurse Specialist
License Number2008008396
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number81733
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number81733
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number81733
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number81733
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: