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Provider Information for 1871852079


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RYAN E ROBERTS


Sex: Female

NPI: 1871852079
Last Updated: 2015-04-16
Certification Date:

Details

NameValue
NPI1871852079
Enumeration Date2012-05-08
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 40 MANSFIELD AVE
WILLIMANTIC, CT 06226-2018
United States

Phone: | Fax:
 
Primary Practice Address 202 POMFRET ST
PUTNAM, CT 06260-1833
United States

Phone: 860-963-7917 | Fax:860-963-0015
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YP2500X - Counselor - ProfessionalCT2733