Provider Demographics
NPI:1306234422
Name:ROBERTS-DALEY, CAROLINE MONICA
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:MONICA
Last Name:ROBERTS-DALEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 QUAPAW TRL
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-6691
Mailing Address - Country:US
Mailing Address - Phone:972-768-6747
Mailing Address - Fax:214-653-6379
Practice Address - Street 1:1304 QUAPAW TRL
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-6691
Practice Address - Country:US
Practice Address - Phone:972-768-6747
Practice Address - Fax:214-653-6379
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3552106H00000X
TX172751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist