Provider Demographics
NPI:1992261861
Name:YEHUDA ROBERTS COUNSELING LLC
Entity type:Organization
Organization Name:YEHUDA ROBERTS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YEHUDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:216-509-3056
Mailing Address - Street 1:65 CABLES AVE APT 22
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06710-1645
Mailing Address - Country:US
Mailing Address - Phone:216-509-3056
Mailing Address - Fax:
Practice Address - Street 1:51 SHERMAN HILL RD STE 203
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-3648
Practice Address - Country:US
Practice Address - Phone:216-509-3056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty