Healthcare Provider Details

I. General information

NPI: 1083068365
Provider Name (Legal Business Name): ROBERTTA THORYK PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10546 BELL RD
NEWBURY OH
44065-9126
US

IV. Provider business mailing address

10546 BELL RD
NEWBURY OH
44065-9126
US

V. Phone/Fax

Practice location:
  • Phone: 216-704-3781
  • Fax:
Mailing address:
  • Phone: 216-704-3781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberCL1008937
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: