Healthcare Provider Details

I. General information

NPI: 1982302568
Provider Name (Legal Business Name): ELIZABETH ROBERTS LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 GRANDVIEW RD
BEAVER WV
25813-9105
US

IV. Provider business mailing address

180 BRANCHWOOD LN
DANIELS WV
25832-9789
US

V. Phone/Fax

Practice location:
  • Phone: 304-640-3883
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberF018955
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: