Provider Demographics
NPI:1043384787
Name:ROBERTS, DEBRA L (LADC, LICSW)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LADC, LICSW
Other - Prefix:MS
Other - First Name:DEBRA
Other - Middle Name:L
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:128 MERCHANTS ROW
Mailing Address - Street 2:SUITE 611- 612
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-5911
Mailing Address - Country:US
Mailing Address - Phone:802-786-8008
Mailing Address - Fax:
Practice Address - Street 1:128 MERCHANTS ROW
Practice Address - Street 2:SUITE 611- 612
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-5911
Practice Address - Country:US
Practice Address - Phone:802-786-8008
Practice Address - Fax:802-786-8008
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000207101YA0400X
VT089-00005211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT364282OtherMVP
VT2172180OtherCIGNA
VT59865OtherBLUE CROSS,BLUE SHIELD
VT115219OtherTEAMSTERS BEHAV. HEALTH
VT1010145Medicaid
VT589706000OtherMAGELLAN
VT1010145Medicaid