MEDICARE: CHRISTINA R ROUBICEK 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	101YM0800X	Mental Health Counselor	4233	NE
2	1041C0700X	Clinical Social Worker	1499	NE

General Provider Information

NPI Number	:	1174968994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA R ROUBICEK LCSW

Provider Business Mailing Address
First Line	:	10806 PRAIRIE HILLS DRIVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68144-4830
Country	:	US
Telephone Number	:	402-321-8995
Fax Number	:

Provider Business Practice Location Address
First Line	:	10806 PRAIRIE HILLS DR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68144-4830
Country	:	US
Telephone Number	:	402-321-8995
Fax Number	:

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

Provider Enumeration Date	:	05/07/2013
Last Update Date	:	05/07/2013

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