Healthcare Provider Details

I. General information

NPI: 1588840169
Provider Name (Legal Business Name): MRS. MICHELLE ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MARKET ST.
CAMDEN NJ
80102
US

IV. Provider business mailing address

400 MARKET ST.
CAMDEN NJ
80102
US

V. Phone/Fax

Practice location:
  • Phone: 856-541-1700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: