MEDICARE: TAMARA ROBERTS PH.D.

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
1	103T00000X	Psychologist	129250	KY

General Provider Information

NPI Number	:	1396758579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA ROBERTS PH.D.

Provider Business Mailing Address
First Line	:	159 SAINT MATTHEWS AVE STE 3
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-3137
Country	:	US
Telephone Number	:	502-721-0435
Fax Number	:	502-721-0436

Provider Business Practice Location Address
First Line	:	159 SAINT MATTHEWS AVE STE 3
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-3137
Country	:	US
Telephone Number	:	502-721-0435
Fax Number	:	502-721-0436

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	02/13/2017

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