Provider Demographics
NPI:1053188615
Name:ROBERTO, DOUGLAS WILLIAM (DARC, RCP)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:WILLIAM
Last Name:ROBERTO
Suffix:
Gender:M
Credentials:DARC, RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-8059
Mailing Address - Country:US
Mailing Address - Phone:203-843-4143
Mailing Address - Fax:
Practice Address - Street 1:14 VILLAGE RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-8059
Practice Address - Country:US
Practice Address - Phone:203-843-4143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)