Healthcare Provider Details

I. General information

NPI: 1245383512
Provider Name (Legal Business Name): GENEVA R ROBERTS PHD LCSWC LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 A MAIN STREET
LAUREL MD
20707
US

IV. Provider business mailing address

27 AVENTURA COURT
RANDALLSTOWN MD
21133
US

V. Phone/Fax

Practice location:
  • Phone: 301-490-0550
  • Fax: 301-490-9758
Mailing address:
  • Phone: 410-922-4475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10512
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC301707
License Number StateDC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: