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NPI Code Detail

MEDICARE: MICAH ROBERTS LPC

MEDICARE: MICAH ROBERTS LPC
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
1101YP2500XProfessional CounselorPC008454PA

General Provider Information

NPI Number : 1891160214
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICAH ROBERTS LPC
Provider Business Mailing Address
First Line : 1348 BAINBRIDGE ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19147-1810
Country : US
Telephone Number : 215-563-0652
Fax Number :
Provider Business Practice Location Address
First Line : 1348 BAINBRIDGE ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19147-1810
Country : US
Telephone Number : 215-563-0652
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2015
Last Update Date : 08/14/2022

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Directions to “ MICAH ROBERTS LPC” Practice Location

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