=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225454564
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLAIRE ROBERTS, LCSW, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2014
-----------------------------------------------------
Last Update Date | 03/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4446 27 RT. SUITE 2
-----------------------------------------------------
City | KINGSTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08528-0242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-240-6092
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4446 PRINCETON KINGSTON RD.
-----------------------------------------------------
City | KINGSTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08528-0242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOTHERAPIST
-----------------------------------------------------
Name | CLAIRE ROBERTS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 609-240-6092
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 44SC05335500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------