Healthcare Provider Details

I. General information

NPI: 1740554385
Provider Name (Legal Business Name): MARILYN RUTH ROBERTS LCSW-BACS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARILYN R ROBERTS LCSW-BACS

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 GENERAL MEYER AVE
NEW ORLEANS LA
70131-3588
US

IV. Provider business mailing address

4422 GENERAL MEYER AVE
NEW ORLEANS LA
70131-3588
US

V. Phone/Fax

Practice location:
  • Phone: 504-361-6092
  • Fax: 504-361-6256
Mailing address:
  • Phone: 504-361-6092
  • Fax: 504-361-6256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3423
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: