MEDICARE: DR. BARBARA ROBERTS BCBA, ED.D, MA, SPED

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	103TB0200X	Cognitive & Behavioral Psychologist	1-03-1196	FL

General Provider Information

NPI Number	:	1881668994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARBARA ROBERTS BCBA, ED.D, MA, SPED

Provider Business Mailing Address
First Line	:	2759 OCEAN OAKS DR N
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-4826
Country	:	US
Telephone Number	:	904-321-2771
Fax Number	:

Provider Business Practice Location Address
First Line	:	2759 OCEAN OAKS DR N
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-4826
Country	:	US
Telephone Number	:	904-321-2771
Fax Number	:

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	07/08/2007

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