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General NPI Number Information
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NPI Number | 1982416731
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Entity Type | Individual
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Provider Name | MARIESSA ROBLES PSYD
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Gender |
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Dates
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Enumeration Date | 01/20/2025
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 301 S INGERSOLL ST
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City | MADISON
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State | WI
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Zip | 53703-3705
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Country | US
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Telephone | 608-616-9755
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Fax |
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Provider Business Mailing Address
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Address Line | 301 S INGERSOLL ST APT 311
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City | MADISON
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State | WI
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Zip | 53703-3903
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Country | US
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Telephone | 608-616-9755
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 517157
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License Number State | WI
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