Provider Demographics
NPI:1427334465
Name:ROBERTS, EUGENE THEODORE
Entity type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:THEODORE
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19079-2302
Mailing Address - Country:US
Mailing Address - Phone:610-809-6130
Mailing Address - Fax:
Practice Address - Street 1:634 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:SHARON HILL
Practice Address - State:PA
Practice Address - Zip Code:19079-2302
Practice Address - Country:US
Practice Address - Phone:610-809-6130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health