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General NPI Number Information
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NPI Number | 1225194343
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Entity Type | Individual
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Provider Name | MARK ROBERTS PH.D.
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Gender | Male
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Dates
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Enumeration Date | 01/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 405 E 73RD ST
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City | NEW YORK
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State | NY
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Zip | 10021-3865
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Country | US
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Telephone | 212-787-3128
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 NETHERLAND AVE APT 2401
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City | BRONX
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State | NY
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Zip | 10463-4839
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Country | US
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Telephone | 718-884-1488
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 000556
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License Number State | NY
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