Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 6533 CLINICAL PSYCHO | MA |
N | 103T00000X | Psychologist | 6533 CLINICAL PSYCHO | MA |
N | 103TA0700X | Adult Development & Aging Psychologist | 6533 | MA |
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 6533 | MA |
N | 103G00000X | Clinical Psychologist | 6533 | MA |
N | 103TC0700X | Clinical Psychologist | 6533 | MA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 6533 | MA |
N | 103TF0000X | Family Psychologist | 6533 | MA |
N | 103TH0004X | Health Psychologist | 6533 CLINICAL PSYCH | MA |
N | 103TH0100X | Health Service | 6533 | MA |
N | 103TM1800X | Intellectual & Developmental Disabilities | 6533 | MA |
N | 103TP2701X | Group Psychotherapist | 6533 | MA |
N | 103TR0400X | Rehabilitation Psychologist | 6533 | MA |
N | 103TS0200X | School Psychologist | 6533 CLINICAL PSYCH | MA |
NPI | 1396951422 |
---|---|
Provider Name | Dr. Roberta D Conant |
First Address | Jamaica Plain, MA 02130-4016 |
Second Address | Brookline, MA 02445-7937 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 18/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020623 | (05) | MA |
11835347 | CAQH (01) |