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General NPI Number Information
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NPI Number | 1770689093
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Entity Type | Individual
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Provider Name | SIMONE SUZETTE ROBERTS LMSW
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Gender | Female
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7400 MERTON MINTER AUDIE MURPHY VETERANS MEMORIAL HOSPITAL
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City | SAN ANTONIO
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State | TX
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Zip | 78240
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Country | US
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Telephone | 210-699-2159
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Fax |
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Provider Business Mailing Address
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Address Line | 9734 AUTUMN VALLEY
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City | CONVERSE
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State | TX
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Zip | 78109
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Country | US
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Telephone | 210-659-8301
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 40250
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License Number State | TX
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