Individual
MRS. VERENA M. ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
465 MEMORIAL DR, POCATELLO, ID 83201-4008
(208) 232-7862
Mailing address
500 S 11TH AVE STE 400, POCATELLO, ID 83201-4880
(208) 232-7862
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC0700X
Clinical Psychologist
PENDING APPROVAL
CO
103TC0700X
Clinical Psychologist
Primary
PSY-202880
ID
103TH0100X
Health Service Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
024134
KAISER COMMERCIAL NUMBER
CO
05
—
80839860
—
CO
Enumeration date
09/23/2011
Last updated
08/11/2021
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