Healthcare Provider Details

I. General information

NPI: 1457456857
Provider Name (Legal Business Name): DEBORAH M ROBERTS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 VILLAGE SQUARE DR STE 302
SOUTH KINGSTOWN RI
02879-2569
US

IV. Provider business mailing address

PO BOX 915
PORTSMOUTH RI
02871-0915
US

V. Phone/Fax

Practice location:
  • Phone: 401-785-0400
  • Fax:
Mailing address:
  • Phone: 401-743-3626
  • Fax: 401-683-0753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110402
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLADC1
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW01460
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: