MEDICARE: MRS. MARIA MAY ROBERTS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904004237	VA
2	1041C0700X	Clinical Social Worker	68076	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0904004237	OTHER	VA	LICENSE

General Provider Information

NPI Number	:	1013015494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA MAY ROBERTS LCSW

Provider Business Mailing Address
First Line	:	1145 1ST ST
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-5326
Country	:	US
Telephone Number	:	703-606-4642
Fax Number	:

Provider Business Practice Location Address
First Line	:	1611 S PACIFIC COAST HWY
Second Line	:	SUITE 305
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-5606
Country	:	US
Telephone Number	:	703-606-4642
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	02/08/2017

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