Healthcare Provider Details

I. General information

NPI: 1740080266
Provider Name (Legal Business Name): ROBYN ROGERS LISW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3869 SOLDIER ST
COLUMBUS OH
43232-4980
US

IV. Provider business mailing address

4720 ELLIOTT RD
HILLIARD OH
43026-7648
US

V. Phone/Fax

Practice location:
  • Phone: 614-347-3886
  • Fax:
Mailing address:
  • Phone: 614-537-6151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberI1100133
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberI1100133
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI1100133
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: