Healthcare Provider Details

I. General information

NPI: 1093520488
Provider Name (Legal Business Name): MARIELLA ROBERTS LPCMH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WASHINGTON AVE
TALLEYVILLE DE
19803-2353
US

IV. Provider business mailing address

200 WASHINGTON AVE
TALLEYVILLE DE
19803-2353
US

V. Phone/Fax

Practice location:
  • Phone: 302-966-3058
  • Fax:
Mailing address:
  • Phone: 302-966-3058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARIELLA ROBERTS
Title or Position: OWNER
Credential:
Phone: 302-966-3058