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General NPI Number Information
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NPI Number | 1114064078
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Entity Type | Individual
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Provider Name | JOHN E. ROBERTS LCMHC
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Gender | Male
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 12/27/2023
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Provider Practice Location Address
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Address Line | 34 ELMWOOD AVE
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City | BURLINGTON
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State | VT
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Zip | 05401-4346
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Country | US
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Telephone | 802-922-5935
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Fax |
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Provider Business Mailing Address
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Address Line | 34 ELMWOOD AVE
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City | BURLINGTON
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State | VT
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Zip | 05401-4346
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Country | US
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Telephone | 802-922-5935
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Fax | 802-857-0176
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 068-0000696
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License Number State | VT
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