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NPI Code Detail

MEDICARE: MRS. PETRONELLA I ROOME ROBERTS BA. MA.

MEDICARE: MRS. PETRONELLA I ROOME ROBERTS BA. MA.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1306087341
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. PETRONELLA I ROOME ROBERTS BA. MA.
Provider Business Mailing Address
First Line : 1434 SHELBY ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46203-1945
Country : US
Telephone Number : 317-655-3218
Fax Number :
Provider Business Practice Location Address
First Line : 1434 SHELBY ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46203-1945
Country : US
Telephone Number : 317-655-3218
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2009
Last Update Date : 03/22/2009

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