Provider Demographics
NPI:1699895771
Name:ROBERTS, MARYANN (LPC LICENSED PROFESS)
Entity type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LPC LICENSED PROFESS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 KIMBLE COURT
Mailing Address - Street 2:
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444
Mailing Address - Country:US
Mailing Address - Phone:973-835-2119
Mailing Address - Fax:
Practice Address - Street 1:287 BOULEVARD
Practice Address - Street 2:
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444
Practice Address - Country:US
Practice Address - Phone:973-831-9447
Practice Address - Fax:973-835-8010
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00080400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional