Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PS-005683-L | PA |
Y | 103TC0700X | Clinical Psychologist | PS-005683-L | PA |
NPI | 1003903006 |
---|---|
Provider Name | Mr. Scott B. Roberts |
First Address | Waynesburg, PA 15370-1349 |
Second Address | Waynesburg, PA 15370-1349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 09/07/2007 |