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General NPI Number Information
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NPI Number | 1407918410
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Entity Type | Individual
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Provider Name | MARY ALICE ROBERTS
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Gender | Female
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 10/21/2009
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Provider Practice Location Address
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Address Line | 149 E 78TH ST ACKERMAN INSTITUTE
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City | NEW YORK
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State | NY
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Zip | 10075-0405
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Country | US
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Telephone | 914-450-8676
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 5TH AVE 9 D
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City | NEW YORK
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State | NY
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Zip | 10028-0130
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Country | US
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Telephone | 914-450-8676
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 075021
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License Number State | NY
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