Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 2634 | OH |
Y | 103TC0700X | Clinical Psychologist | 2634 | OH |
NPI | 1013066075 |
---|---|
Provider Name | Dr. Janice Shirley Roberts |
First Address | Toledo, OH 43615-1906 |
Second Address | Toledo, OH 43615-1906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 11/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0160758 | (05) | OH |
1281534 | CIGNA (01) | OH |
22000000348931 | ANTHEM BCBS (01) | OH |
276396 | ABDA DIS (01) | OH |