Provider Demographics
NPI:1306087341
Name:ROOME ROBERTS, PETRONELLA I (BA MA)
Entity type:Individual
Prefix:MRS
First Name:PETRONELLA
Middle Name:I
Last Name:ROOME ROBERTS
Suffix:
Gender:F
Credentials:BA MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 SHELBY ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-1945
Mailing Address - Country:US
Mailing Address - Phone:317-655-3218
Mailing Address - Fax:
Practice Address - Street 1:1434 SHELBY ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-1945
Practice Address - Country:US
Practice Address - Phone:317-655-3218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-22
Last Update Date:2009-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health