Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0004X | Health Psychologist | 1552 | KY |
NPI | 1053716522 |
---|---|
Provider Name | Stephanie Marie Roby |
First Address | Louisville, KY 40206-1499 |
Second Address | Louisville, KY 40206-1433 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2014 |
Last Update Date | 27/10/2014 |