Provider Demographics
NPI:1013015494
Name:ROBERTS, MARIA MAY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:MAY
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-5326
Mailing Address - Country:US
Mailing Address - Phone:703-606-4642
Mailing Address - Fax:
Practice Address - Street 1:1611 S PACIFIC COAST HWY
Practice Address - Street 2:SUITE 305
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5606
Practice Address - Country:US
Practice Address - Phone:703-606-4642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040042371041C0700X
CA680761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904004237OtherLICENSE