Healthcare Provider Details

I. General information

NPI: 1730437179
Provider Name (Legal Business Name): ROBERTA ALLEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 MERCY HEALTH PL
CINCINNATI OH
45237-6147
US

IV. Provider business mailing address

1701 MERCY HEALTH PL
CINCINNATI OH
45237-6147
US

V. Phone/Fax

Practice location:
  • Phone: 513-853-8520
  • Fax:
Mailing address:
  • Phone: 513-853-8520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.015417
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2203986
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904014606
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: