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General NPI Number Information
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NPI Number | 1841816956
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Entity Type | Organization
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Legal Business Name | ANGELA OLIVIA ROBERTS, APRN, LLC
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Dates
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Enumeration Date | 06/24/2020
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Last Update Date | 06/24/2020
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Provider Practice Location Address
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Address Line | 427 NAUBUC AVE STE 101
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City | GLASTONBURY
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State | CT
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Zip | 06033-1082
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Country | US
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Telephone | 959-207-1951
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Fax | 888-845-1141
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Provider Business Mailing Address
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Address Line | 3021 MAIN ST
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City | ROCKY HILL
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State | CT
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Zip | 06067-3765
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Country | US
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Telephone | 860-256-9367
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ANGELA OLIVIA ROBERTS
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Credential | APRN
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Telephone | 959-207-1951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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