=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770596561
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THERESA E. ROBERTS MS, LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2006
-----------------------------------------------------
Last Update Date | 05/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 71 MAIN ST SUITE 2A
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01473-1472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-302-5712
-----------------------------------------------------
Fax | 978-272-1395
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28 DEERFIELD DRIVE
-----------------------------------------------------
City | GROTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01450-1567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-448-5688
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 6019
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------