Healthcare Provider Details

I. General information

NPI: 1073734208
Provider Name (Legal Business Name): BRENDA GABRIELLE ROBERTS-CLINE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 2ND ST NE
CANTON OH
44704-1132
US

IV. Provider business mailing address

202 CLARA CT
LOUISVILLE OH
44641-1010
US

V. Phone/Fax

Practice location:
  • Phone: 330-454-7917
  • Fax: 330-454-1476
Mailing address:
  • Phone: 330-875-3051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS. 0026286
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: