=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790820488
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHARON LYNN ROBERTS MA, LPC, LCADC, NCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2007
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2301 E EVESHAM RD STE 109
-----------------------------------------------------
City | VOORHEES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08043-4502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-319-5550
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 304 ALBANY AVE
-----------------------------------------------------
City | BARRINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08007-1032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-977-7736
-----------------------------------------------------
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 | R0913
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------