Healthcare Provider Details

I. General information

NPI: 1053284596
Provider Name (Legal Business Name): ELIZABETH LACEY ROBERTS PSYCH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH ROBERTS PSYCH CRNP

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 CHEMUNG ST
CORNING NY
14830-2735
US

IV. Provider business mailing address

145 CHEMUNG ST
CORNING NY
14830-2735
US

V. Phone/Fax

Practice location:
  • Phone: 570-250-7837
  • Fax:
Mailing address:
  • Phone: 570-250-7837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407737
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP033921
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: