Provider Demographics
NPI:1962889956
Name:ROLEY-ROBERTS, MICHELLE E (MA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:E
Last Name:ROLEY-ROBERTS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:E
Other - Last Name:ROLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7261 MERCY RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2311
Mailing Address - Country:US
Mailing Address - Phone:402-398-6248
Mailing Address - Fax:402-829-8513
Practice Address - Street 1:7101 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68152-2164
Practice Address - Country:US
Practice Address - Phone:402-572-2916
Practice Address - Fax:402-572-3258
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE983103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist